Algorithm-based analysis of lymph node dissection strategies and survival outcomes in primary oral squamous cell carcinoma.

INTRODUCTION

Recent advancements in treatment approaches for oral squamous cell carcinomas (OSCCs) necessitate a reevaluation of neck dissection techniques and their impact on patient outcomes and morbidity.

METHODS

This retrospective study of 250 OSCC patients recruited between 2017-2022 examined the association between neck dissection techniques and survival metrics. Our cohort, drawn from a primary OSCC surgery population at our clinic, provided a rich dataset encompassing demographics, clinical parameters, and detailed surgical records. Two neck dissection techniques were analyzed: the Supraomohyoid Selective Neck Dissection (SND), which targets lymph nodes at Levels I-III, and Other Dissections (OD), which involve a more extensive extraction including Levels IV and V. Kaplan-Meier survival curves and Cox proportional hazards models assessed the influence of lymph node dissection on postoperative outcomes.

RESULTS

Findings indicated that each additional lymph node removed was associated with a 0.289-day increase in hospitalization (p = 0.002), yet no significant link was found between dissection techniques or total lymph node extraction count and survival metrics. Levels I to III emerged as critical areas with the highest likelihood of yielding tumor-positive lymph nodes, emphasizing the significance of these levels.

DISCUSSION: The study suggests that more extensive dissection does not necessarily confer survival benefits, highlighting the importance of strategic surgical focus and the potential for tailored interventions that prioritize disease-specific lymph node levels to optimize patient recovery and prognosis.