The Role of Bilateral Versus Ipsilateral Neck Dissection in Oropharyngeal and Oral Cancer with Contralateral cN0 Neck in cT3 and cT4 Disease

Abstract

Introduction: Head and neck cancer (HNC) is a significant global health issue, with Head and Neck Squamous Cell Carcinoma (HNSCC) ranking among the most prevalent cancers worldwide. In particular, India faces high incidence rates due to tobacco and areca nut usage. While HNSCC primarily affects the oral cavity carcinoma (OC), larynx, and oropharyngeal carcinoma (OPC) outcomes are linked to HPV status and T-, N-, and M-status. The necessity of elective neck dissection (END) for contralateral clinically node-negative (cN0) necks remains debated, with limited literature on its impact. Methodology: This retrospective study analyzed 300 OC/OPC patients with contralateral cN0 necks who underwent bilateral or ipsilateral neck dissection. Data on patient demographics, tumor characteristics, and treatment outcomes were collected over three years. Survival analysis employed Kaplan-Meier techniques and Cox regression. Result: In OC/OPC, midline-reaching/crossing tumors were more common with bilateral neck dissection, but contralateral neck node metastasis was rare. There was no significant difference in OS or RFS between ipsilateral and bilateral neck dissection groups. Conclusion: Contralateral neck dissection in OC/OPC patients with clinically node-negative necks did not enhance OS or RFS. The potential benefits of wait-and-scan strategies warrant further investigation through prospective trials. Keywords: Head and Neck cancer (HNC), Oropharyngeal squamous cell carcinoma (OPC), Elective neck dissection (END), Recurrence free survival (RFS)