ELECTIVE NECK DISSECTION VERSUS OBSERVATION IN THE MANAGEMENT OF SQUAMOUS CELL CARCINOMA OF TONGUE WITH CLINICALLY NODE NEGATIVE NECK- A SYSTEMATIC REVIEW

Abstract

Background:

Early oral squamous cell carcinoma are reported to be about 90% of all the oral cancers especially in older individuals more specific to males. Though etiology is multifactorial it can be strongly related to tobacco and alcohol abuse other factors like Human papillomaviruses (HPV16-18), genetic factors and pre-neoplastic lesions also play a major role in the etiology of oral squamous cell carcinoma. There is no consensus in the literature for the treatment of early squamous cell carcinoma of the tongue (stages I–II); both an elective neck dissection as well as observation policy have their proponents in various centres’ globally.

Aim: The systematic review aims to analyse if elective neck dissection or observation without neck dissection gives good prognosis for patients diagnosed with squamous cell carcinoma of the tongue in terms of recurrence rates and survival rates.

Materials And Methods: PROSPERO registration was obtained before beginning of the study. PROSPERO ID : CRD42023430920.PubMed/Medline, Cochrane and Google Scholar were searched comprehensively to identify relevant literature. Manual search was also done from the esteemed journals pertaining to the fields of Oral Surgery, Oral Pathology , Oral Medicine, Radiology, International Journal of Oral and Maxillofacial Surgery (IJOMS); and British Journal of Oral and Maxillofacial Surgery(BJOMS). Four studies were selected following PRISMA guidelines and inclusion criteria. All the included studies were retrospective studies. Literature abstracts and full text articles were analysed in this review. Two reviewers independently assessed the full text of included articles and extracted data items related to research questions. Further, quality of assessment of all the included studies was done with the Risk of bias assessment tools.

Results: Four studies were short listed and included in this review as per PRISMA guidelines. All the included studies were retrospective studies. The methodological quality of the studies was graded moderate to low. The outcome concerned the comparison between elective neck dissection and observation in the management of squamous cell carcinoma of the oral tongue with node negative neck clinically and to asses which one has the better prognosis. Based on results analysed from the included studies it can be concluded for lesions falling under T1 Category observation with out neck dissection can be a treatment of choice if only the treatment for primary tumour resections is in strict compliance with cancer surveillance protocol, while in cases of T2, T3 and T4 all the included studies showed that there less local recurrence rates and more survival rates in groups where elective neck dissection was done over observation group.

Conclusion: Based on the cumulative results obtained from the included studies, most of the authors concluded that in T1 lesions with no neck node involvement wait full watching and observation can be the treatment of choice. In T2, T3, T4 lesions with no neck involvement authors have advised to go for elective neck dissection as treatment of choice. Recent advances like Sentinal node biopsy can be used as a good diagnostic tool to evaluate for presence of disease in the neck.More prospective clinical trails should be done to further evaluate the benefit of elective neck dissection done based on the reports obtained by sentinel lymph node biopsy in the treatment of early stages of SCC.