The role of elective neck dissection in early stage buccal cancer

Objectives/Hypothesis The 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 Design Retrospective case‐control study. Methods One 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. Results The 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. Conclusions END 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 Evidence 4 Laryngoscope, 125:128–133, 2015