The Role of Elective Neck Dissection in Early Stage Buccal Cancer

Objectives/HypothesisThe benefits of elective neck dissection (END) in early-stage tongue cancer have been widely discussed but are still controversial regarding early-stage buccal cancer. In this study, we evaluate the role of END and the treatment outcome in early-stage buccal cancer in an areca-quid endemic area. Study DesignRetrospective case-control study. MethodsOne hundred seventy-three cT1-2N0M0 buccal cancer patients all staged by computed tomography or magnetic resonance imaging were recruited. A total of 151 patients received radical surgery with END, whereas 22 received observation (OBS). Adjuvant radiotherapy with or without chemotherapy was given in selected high-risk patients. ResultsThe 5-year overall survival (OS) rates for cT1 lesions and cT2 lesions were 86.14% and 75.45%, respectively (P=.105). In the END group, the occult metastasis rate was 1.8% for cT1 lesions and 10.6% for cT2 lesions (P=.053). The 5-year neck control rate rates (P=.001) and disease-free survival rates (P=.0101) were significantly better in the END group compared to the OBS group but were not significant in OS (P=.689). Eighteen (10.41%) patients developed a second primary tumor (SPT), and five (2.89%) patients developed a third primary tumor. Ninety-four percent of SPTs were located within the oral cavity. ConclusionsEND was suggested in T1-T2N0 buccal cancer to improve the neck control rate. In patients for whom END is not performed at the time of tumor excision, regular follow-up of neck status is necessary because the metastatic lesions are mostly salvageable and do not influence the OS. Level of Evidence4 Laryngoscope, 125:128-133, 2015