American Head and Neck Society Reviews Recommendations on Surgical Management of the Neck in Patients with Oral Cancer

CLINICAL QUESTION

What are the current recommendations regarding surgical management of the neck in patients with oral cancer, specifically in regard to the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma (SCC)?

BOTTOM LINE

This American Head and Neck Society (AHNS) review offers a surgically explicit discussion of management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity SCC while balancing surgical risk and oncologic outcome.

BACKGROUND: Oral cavity SCC has a high propensity for regional lymph node metastasis. Optimizing patient outcomes in oral cavity SCC management involves balancing the risk from treatment against the risk from disease. There is still inconsistency and occasional controversy regarding the surgical management of the neck in patients with oral cancer.

STUDY DESIGN: Literature review

SETTING: Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

SYNOPSIS: Members of the Mucosal Section of the AHNS put together a literature review designed to describe the evidence surrounding commonly encountered clinical scenarios in the management of the neck in patients with oral cancer. They conducted a literature search and presented their findings, along with literature quality ratings of 1–5 based on the modified Oxford Centre for Evidence-based Medicine. Recommendations were organized by subject sections as follows: imaging considerations (computed tomography, magnetic resonance imaging, ultrasonography, and positron emission tomography), staging classification, depth of invasion, elective neck dissection (END) by T category, extent of END, sentinel lymph node biopsy (SLNB), extent of therapeutic neck dissection, post-treatment surveillance, lymph node yield, and neck dissection specimen handling. The researchers concluded that recent literature would suggest that patients with oral cavity cancer should be fully staged pre-operatively, and most patients should receive a neck dissection even when clinically N0. They also stated that specimen labeling should be performed at the time of surgery to separate each level, that lymph node yield should include 18 or more nodes, and that SLNB can be considered in select tumors and within a well-trained team.

CITATION: Eskander A, et al. Oral cavity cancer surgical and nodal management: a review from the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg. 2024;150:172-178. doi:10.1001/jamaoto.2023.4049.