Evaluation of prophylactic neck dissection in Stage I and II oral squamous cell carcinoma

Abstract

The control of neck lymph node metastasis in oral cancer is an important determinant of the prognosis. However, the effectiveness of prophylactic neck dissection has long been debated, without reaching a clear consensus.
Although our department performed prophylactic neck dissection before 1995, the use of this procedure has decreased markedly since then. Currently, we perform therapeutic neck dissection in patients with metastasis. Prophylactic neck dissection in the pure sense, excluding procedures involving reconstruction, has not been performedsince April 1997.
This study was designed to investigate the effectiveness of prophylactic neck dissection in Stage I and II oral squamous cell carcinoma. Ninety-one patients with primary Stage I and II disease treated in our department between 1992 and 2002 were retrospectively evaluated according to whether they underwent prophylactic neck dissection or not.
1. In Stage I, the 5-year cumulative survival rate was 88.9 % in the group that underwent prophylactic neck dissection and 91.4 % in the group that did not.
2. In Stage II, the 5-year cumulative survival rate was 93.3 % in the group that underwent prophylactic neck dissection and 86.4 % in the group that did not.
3. By closely following up patients and performing therapeutic neck dissection as soon as possible for neck lymph node metastasis, our results suggest that prophylactic neck dissection at initial surgery is not necessarily required in patients with stage I and II oral squamous cell carcinoma.