Management of the Contralateral Neck in Unilateral Node-Positive Oral Squamous Cell Carcinoma

SIMPLE SUMMARY: Elective management of the contralateral neck in lateralized oral squamous cell carcinoma remains a matter of debate, and current guidelines provide only little guidance in this regard. Especially patients with ipsilateral cervical lymph node metastasis are of interest since several studies showed a higher risk for contralateral metastasis in these cases. The present study is a retrospective analysis of this cohort over a 10-year period at a high-volume tumor center in Germany. The results of this study show that the prevalence of occult contralateral neck metastases is low, and that contralateral elective neck dissection should not be performed routinely in this cohort. ABSTRACT: Introduction: In lateralized oral squamous cell carcinoma (OSCC) with ipsilateral cervical lymph node metastasis (CLNM), the surgical management of the unsuspicious contralateral neck remains a matter of debate. The aim of this study was to analyze this cohort and to compare the outcomes of patients with and without contralateral elective neck dissection (END). Material and Methods: A retrospective analysis of patients with lateralized OSCC, ipsilateral CLNM (pN+) and contralateral cN0-stage was performed. Patients were divided into two groups according to the surgical management of the contralateral neck: I: END; and II: no END performed. Adjuvant radiotherapy was applied bilaterally in both groups according to individual risk. Results: A total of 65 patients (group I: 16 (24.6%); group II: 49 (75.4%)) with a median follow-up of 28 months were included. Initially, there was no case of contralateral CLNM after surgery. During follow-up, 6 (9.2%) patients presented with recurrent CLNM. In 5 of these cases (7.7%), the contralateral neck (group I: 3/16 (18.8%); group II: 2/49 (4.1%)) was affected. Increased ipsilateral lymph node ratio was associated with contralateral CLNM (p = 0.07). END of the contralateral side showed no significant benefit regarding OS (p = 0.59) and RFS (p = 0.19). Conclusions: Overall, the risk for occult contralateral CLNM in patients with lateralized OSCC ipsilateral CLNM is low. Our data suggest that END should not be performed routinely in this cohort. Risk-adapted radiotherapy of the contralateral neck alone seems to be sufficient from the oncological point of view.