Is Prophylactic Neck Dissection a “Must” in Early-stage Lip Cancer?

Abstract

Standard lip cancer (LC) treatment is surgical excision with therapeutic neck dissection (ND) when there is detectable metastasis to the cervical lymph nodes (LNs). Nevertheless, there is no general agreement over how to approach to N0 neck in LC. The aim of this study is retrospectively review the prognoses of T1/T2 N0 LC-cases who underwent prophylactic ND, for justification of this procedure. Material and Methods: The study included 50 consecutive early-stage LC-patients, who were operated on between 2013 and 2023. A retrospective review was made of the clinical findings including tumor location, T-grade, detectable regional LN involvements, surgical and adjuvant therapies, histopathological results, recurrences, and metastases. Results: The 50 patients comprised of 36 (72%) males and 14 (28%) females with a 70.94 years mean age. Squamous cell carcinoma was the unanimous histologic diagnosis. The tumors were T2 in 12 (24%) and T1 in 38 (76%) patients; well, moderately and poorly differentiated in 22 (44%), 27 (54%), and 1 (2%) cases, respectively. Tumor locations were as follows: 42 (84%) lower lip, 7 (14%) upper lip, 1 (2%) commissure. Resected tumor defects were repaired with primary closure or flap repairs in 38 (76%) patients and in 12 (24%) patients the operations were complemented with unilateral or bilateral (8 and 4 cases, respectively) elective supraomohyoid ND. No LN metastases were found histopathologically in the ND-specimens. Tumor recurrences occurred in 2 (4%) patients. Conclusion: The results of this study suggested that "wait-and-see" and close follow-up at regular intervals is a more rational approach in early-stage N0 LC than prophylactic ND.