Challenging the 20% Rule: Is a Fixed Cutoff Still Appropriate for Elective Neck Dissection in cN0 Necks?
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Gazzini Luca, Rampinelli Vittorio, Atallah Sarah, Brunet Aina, Maharjan Leison, Zaraca Marco, Penezic Ana, Komiażyk Olga, D'Alessio Pasquale, Ayodele Samuel Oluyomi, Galli Andrea, Trecca Eleonora, Di Bari Matteo, Becerik Çağrı, Dahoun Laith, Fidalgo Amaya Roldan, Świątek Dorota, Chacón Paula Pérez, Amadio Domenico, Đorđević Nikola, Gillone Carola, Basak Hazan, Barańska Magda, Ugorova Diana, Ladrière Kylian, Locatello Luca Giovanni, Quarta Federico Giuseppe, Fułek Katarzyna, Nouh Ismail S, Borsetto Daniele, Gobbo Giulia, Laura Elisa, Zanghi Francesca, Gvetazde Shalva, Y‐CEORL GROUP, Fernandez Ignacio Javier, Calabrese Luca, Dallari Virginia
Аннотация
METHODS: An international web-based cross-sectional survey evaluated acceptable risk thresholds and attitudes toward END among head and neck (HN) surgeons, other healthcare professionals, and non-healthcare participants. The primary outcome was the acceptable occult metastasis risk to justify END; secondary outcomes included acceptable 5-year mortality increase and complication trade-offs.
RESULTS: Of 2077 responses, 2008 were analyzed. Overall, 55% would undergo END at ≤ 10% occult metastasis risk and 86% at 20%. Responses differed significantly across groups (p < 0.0001), with lower thresholds among HN surgeons; 57% endorsed END at ≤ 10% and 92% at ≤ 20%. Among HN surgeons, a threshold of 5% or lower was considered sufficient to include the following levels in the dissection: 78% of surgeons for Level IIB, 75% for Level IV, and 69% for Level V. The majority of HN surgeons (90%) considered it more appropriate to calculate the individual risk and discuss the indication with the patient rather than relying on a fixed threshold.
CONCLUSIONS: Most respondents-particularly HN surgeons-favor lower thresholds than the historical 20%, supporting individualized risk-based decision-making rather than reliance on a fixed cut-off.