Is elective neck dissection effective for clinical cervical node-negative oral squamous cell carcinoma? A systematic review and meta-analysis for the update of the 2019 Japanese Oral Cancer Clinical Practice Guidelines

Abstract

Objective

There is no consensus on whether elective neck dissection should be performed for potential cervical lymph node metastases in patients with clinical cervical node-negative oral cancer. The aim of the present updated systematic review was to clarify the efficacy of elective neck dissection concurrently with resection of the primary tumor in patients with clinical cervical node-negative oral cancer.

Methods

The MEDLINE, Cochrane Central Register of Controlled Trials, and Ichushi-Web databases were searched to identify relevant randomized controlled trials (RCTs). We performed a statistical analysis using the Review Manager 5.4 computer program and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results

Five RCTs were included. The meta-analysis revealed that the hazard ratios for overall survival, disease-free survival, and locoregional control were significantly in favor of elective neck dissection concurrently with resection of the primary tumor. Additionally, the risk difference for shoulder dysfunction after neck dissection was significantly in favor of resection of the primary tumor alone, although this outcome was only investigated in one RCT. The certainty of evidence was low for overall survival, disease-free survival, locoregional control, and shoulder dysfunction after neck dissection.

Conclusion

The present updated systematic review suggests that elective neck dissection should be performed concurrently with resection of the primary tumor in patients with clinical cervical node-negative oral cancer; however, the certainty of evidence was low. Future systematic reviews, including RCTs with larger samples, are expected to confirm the present findings.