Sentinel node biopsy versus elective neck dissection in early-stage oral cancer: a systematic review
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REVIEW ARTICLE
Sentinel node biopsy versus elective neck dissection in early‑stage oral cancer: a systematic review F. M. Crocetta1 · C. Botti1,2 · C. Pernice1 · D. Murri1 · A. Castellucci1 · M. Menichetti1 · M. Costantini3 · F. Venturelli2,4 · M. C. Bassi5 · A. Ghidini1 Received: 10 April 2020 / Accepted: 26 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To provide a summary of the evidence on the comparative effectiveness of two surgical treatment strategies, sentinel node biopsy (SNB) and elective neck dissection (END), in patients with T1–T2 oral cancer and clinically negative (cN0) neck, in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs). Methods A systematic review was performed by including studies published up to April 2019. Meta-analysis was performed to compare NRRs between SNB and END. A narrative summary of the results was generated for OS, DFS and morbidity outcomes. The certainty of evidence was assessed according to the GRADE methodology. Results No randomized studies were retrieved. Five observational studies were included in the comparative effectiveness analysis and four observational studies were included in the comparative morbidity analysis. The pooled risk ratio showed no differences in NRRs between SNB and END (10.5% vs 11.6%; pooled RR 1.09; 95% CI 0.67–1.76). No differences in OS or DFS between the two treatments were found. SNB appears to be associated with a lower rate of postoperative complications and lower shoulder dysfunction than END. Conversely, the results of the quality of life (QoL) questionnaires are not sufficient to advocate a particular strategy. Conclusion Our review highlights the lack of well conducted and randomized studies comparing SNB to END, leading to poor clinical evidence. Although our findings suggest no significant differences in OS, DFS and NRR between the two strategies, the certainty of our evidence is too low to make it useful for clinical decision making. Keywords Oral cancer · Sentinel node biopsy · Neck dissection
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00405-020-06090-9) contains supplementary material, which is available to authorized users. * F. M. Crocetta [email protected] 1
Otorhinolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
2
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
3
Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
4
Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
5
Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Management of the clinically negative (cN0) neck in patients with T1/T2 oral squamous cellular cancer (OSCC) is still considered a field of debate. This issue hinges on two prior conditions. First, the imaging techniques available to date are not sens
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