Elective neck dissection in clinically node-negative oral cavity carcinoma

Elective neck dissection in clinically node-negative oral cavity carcinoma. Background: The management of clinically node-negative oral cavity cancer (cN0 OCC) remains controversial. Here we report the outcomes of patients who underwent elective neck dissection (END) or a watch-and-wait strategy (WWS). Methods: We reviewed the records of cN0 OCC patients who were surgically treated at our institution between 2006 and 2016. The incidence of occult nodal disease and the pattern of recurrence were recorded. Results: A total of 101 patients underwent END, while 130 followed a WWS. END apparently conferred better overall survival compared to WWS (p=0.057). Neck metastases eventually developed in 37 patients (36.6%) in the END group, and in 39 (30.0%) of the WWS group (p=0.287). Levels IV and V, respectively, were positive in 20% and 5% of WWS compared to 8% and 0% of the END group (p=0.024). Regional failure developed in 7/37 patients (18.9%) of the END and 18/39 patients (46.1%) of the WWS group (p=0.011). The highest risk occult neck disease was associated with T3-T4 stage (HR 3.6, p=0.033) and retromolar trigone localization (HR 7.28, p=0.018). Conclusions: The present single-institutional series seems to confirm that END is an oncologically sound procedure for cN0 OCC patients.