Retrospective Study of Selective Submandibular Neck Dissection versus Radical Neck Dissection for N0 or N1 Necks in Level I Patients with Oral Squamous Cell Carcinoma

Abstract

Objective. To evaluate the efficacy of selective submandibular neck dissection (SMND) in patients with oral squamous cell carcinoma (OSCC) with or without nodal metastasis. Patients. From a total of 384 patients with untreated OSCC who underwent radical excision, we identified 229 with clinically N0 necks and 68 with clinically N1 necks in level I. Main Outcome Measures. The Kaplan-Meier 5-year regional control and 5-year disease specific survival (DSS) were compared for SMND, radical neck dissection (RND), and modified radical neck dissection (MRND). Results. In clinically node-negative necks, the regional control rates were 85.2% with SMND and 83.3% with MRND (P = 0.89), and 5-year DSS rates were 86.5% and 87.0%, respectively, (P = 0.94). In clinically N1 necks, the regional control rates were 81.3% with SMND and 83.0% with RND (P = 0.72), and the DSS rates were 81.3% and 80.0%, respectively, (P = 0.94). Type of neck dissection was not significantly associated with regional control or DSS on either univariate or multivariate analysis using Cox's proportional hazard model. Conclusions. SMND can be effectively applied in elective and therapeutic management to patients with OSCC that are clinically assessed as N0 or N1 to level I of the neck.

Modified radical neck dissection vs. selective neck dissection: an analysis of lymph node yield and post-surgical outcomes

“…A total of 181 distinct articles were retrieved. Of these, seven were direct comparisons of MRND vs. SND (or MRND/RND vs. SND) where SCC was the primary lesion [11][12][13][14][15][16][17] and mortality/ recurrence rates were investigated. Six were retrospective studies and one, Robbins et al [15], was prospective.…”

“…This is because direct comparisons of the MRND and SND are problematic due to high levels of variability amongst patient cohorts and treatment regimens. Current studies that directly compare the MRND and SND have tended to focus on mortality and recurrence rates for a variety of primary SCC locations and pre-operative SCC grades [11][12][13][14][15][16][17], though correlation of this data is not yet available. Furthermore, the current literature is lacking in terms of direct comparisons of the MRND and SND concerning variables such as lymph node yield and postoperative complication rates.…”