Supraomohyoid neck dissection (SOHND) refers to the removal of lymph nodes contained in levels I-III and is currently referred to as a selective neck dissection levels I-III. This type of neck dissection has been frequently used in the management of the clinically node-negative neck (cN0) in oral cavity squamous cell carcinoma (OCSCC) and provides similar control rates as more extensive forms of neck dissection. However, several studies have concluded that SOHND is inadequate in patients with OCSCC, owing to occult metastasis to level IV, and that this level should be routinely dissected. Skip metastasis in level IV without involvement of levels I, II or III remains a matter of controversy. Advocates for including level IV in routine neck dissections claim that it minimises neck recurrence and improves prognosis, while opponents remain doubtful of its survival benefit and further argue that it adds morbidity and increases surgical time.

The authors conducted a meta-analysis to scrutinise the rate of skip metastasis to level IV in patients diagnosed with OCSCC without preoperative evidence of neck involvement. The rate of overall involvement of level IV among patients with cN0 was 2.53%. The rate of skip metastasis was extremely low, only 0.5%.

The results of this meta-analysis demonstrate very low rates of skip metastasis to level IV in patients diagnosed with cN0 OCSCC. These findings oppose the routine dissection of level IV in these patients and suggest that SOHND is adequate for this subset of patients.

Assessment of the Rate of Skip Metastasis to Neck Level IV in Patients with Clinically Node-Negative Neck Oral Cavity Squamous Cell Carcinoma: A Systematic Review and Meta-analysis.
Warshavsky A, Rosen R, Nard-Carmel N, et al.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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