Surgical management of the N0 neck in early stage

Authors: R A Ord

Publish Date: 2012/05/13

Volume: 16, Issue: 2, Pages: 181-188

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Abstract

The management of the N0 neck in early stage oral cancer remains controversial The evidence in the literature for elective neck dissection which is reviewed in this paper is conflicting My personal view is that most papers mistakenly assume that the N0 equates to an “early stage” neck whereas a neck with palpable nodes represents disease at a “late” stageI believe that this is the same mindset that prevented us from realizing that depth rather than size was the important prognostic determinant for the primary tumor because the T stage was based on tumor size The N stage is also based on size and number of nodes and by these criteria N0 would be the earliest stage However although an N0 neck with impalpable intranodal disease may be regarded as early impalpable disease an N0 neck with microscopic extracapsular spread ECS would be “late/advanced” impalpable disease Likewise a clinically positive neck with intranodal disease still represents early disease compared to a clinically positive neck with ECS

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