Some evidence that early neck surgery reduces recurrence of the cancer

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There were more than 404,000 new cases of oral cancers worldwide in 2002.  Oral cancer is  the are the sixth most common cancer worldwide, accounting for an estimated 4% of all cancers. Incidence and mortality varies geographically.  Surgery plays an important part of the management of oral cavity cancer with regard to both the removal of the primary tumour and removal of lymph nodes in the neck. Surgery is less frequently used in oropharyngeal cancer.  The aim of this Cochrane review  was to determine which surgical treatment modalities for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and reduced recurrence.

A range of databases were searched ( the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) Medline and Embase via OVID). using no restrictions  regarding language or date of publication.  Randomised controlled trials where more than 50% of participants had primary tumours of the oral cavity or oropharynx, and which compared two or more surgical treatment modalities or surgery versus other treatment modalities were included.

Seven studies were included , but none were assessed as low risk of bias. Trials were grouped into three main comparisons.

  • Four trials compared elective neck dissection (ND) with therapeutic neck dissection in patients with oral cavity cancer and clinically negative neck nodes, but differences in type of surgery and duration of follow-up made meta-analysis inappropriate. Three of these trials reported overall and disease free survival. One trial showed a benefit for elective supraomohyoid neck dissection compared to therapeutic ND in overall and disease free survival. Two trials found no difference between elective radical ND and therapeutic ND for the outcomes of overall survival and disease free survival. All four trials found reduced locoregional recurrence following elective ND.
  • A further two trials compared elective radical ND with elective selective ND and found no difference in overall survival, disease free survival or recurrence. The final trial compared surgery plus radiotherapy to radiotherapy alone but data were unreliable because the trial stopped early and there were multiple protocol violations.
  • None of the trials reported quality of life as an outcome. Two trials, evaluating different comparisons reported adverse effects of treatment.

The authors concluded

Seven included trials evaluated neck dissection surgery in patients with oral cavity cancers. The review found weak evidence that elective neck dissection of clinically negative neck nodes at the time of removal of the primary tumour results in reduced locoregional recurrence, but there is insufficient evidence to conclude that elective neck dissection increases overall survival or disease free survival compared to therapeutic neck dissection. There is very weak evidence from one trial that elective supraomohyoid neck dissection may be associated with increased overall and disease free survival. There is no evidence that radical neck dissection increases overall survival compared to conservative neck dissection surgery. Reporting of adverse events in all trials was poor and it was not possible to compare the quality of life of patients undergoing different surgeries.

Bessell A, Glenny AM, Furness S, Clarkson JE, Oliver R, Conway DI, Macluskey M, Pavitt S, Sloan P, Worthington HV. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev. 2011 Sep 7;9:CD006205. Review. PubMed PMID: 21901703.

Related Reviews

Furness S, Glenny AM, Worthington HV, Pavitt S, Oliver R, Clarkson JE,  Macluskey M, Chan KK, Conway DI. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD006386. Review. PubMed PMID: 21491393.

Glenny AM, Furness S, Worthington HV, Conway DI, Oliver R, Clarkson JE, Macluskey M, Pavitt S, Chan KK, Brocklehurst P; CSROC Expert Panel. Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD006387. Review. PubMed PMID: 21154367.


November is Mouth Cancer Action Month in the UK

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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