Conservative Neck Dissection in Oral Cancer Patients: a 5 Year Retrospective Study in Malaysia

Objective: The impact of ablative oral cancer surgery was studied, with particular reference to recurrence andnodal metastasis, to assess survival probability and prognostic indicators and to elucidate if ethnicity influencesthe survival of patients.
Methods: Patients who underwent major ablative surgery of the head and neck regionwith neck dissection were identified and clinical records were assessed. Inclusion criteria were stage I-IV oraland oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009. Allindividuals had a pre-operative assessment prior to the surgery. The post operative assessment period rangedfrom 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves.
Results: 87 patients(males:38%; females:62%) were included in this study, with an age range of 21-85 years. Some 78% underwentneck dissections while 63% had surgery and radiotherapy. Nodal recurrence was detected in 5.7% while 20.5%had primary site recurrence within the study period. Kaplan-Meier survival analysis revealed that the mediansurvival time was 57 months. One year overall survival (OS) rate was 72.7% and three year overall survival ratedropped to 61.5%. On OS analysis, the log-rank test showed a significant difference of survival between Malayand Chinese patients (Bonferroni correction p=0.033). Recurrence-free survival (RFS) analysis revealed that25% of the patients have reached the event of recurrence at 46 months. One year RFS rate was 85.2% and thethree year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in theevent of recurrence and nodal metastasis (p<0.001).
Conclusion: Conservative neck is effective, in conjunctionwith postoperative radiotherapy, for control of neck metastases. Ethnicity appears to influence the survival ofthe patients, but a prospective trial is required to validate this.