SynthesisBritish journal of cancer2019
Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort.
Synthesis in British journal of cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 3 registered trials, which are not on this map. Cited by 38 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
SEND Trial The Role of Selective Neck Dissection Used Electively in Patients With Early Oral Squamous Cell Carcinoma (1-3cm Primary Size) and No Clinical Evidence of Lymph Node Metastases in the Neck
Sentinel Node Biopsy Versus Limited Elective Neck Dissection in Early Cancers of Oral Cavity NoDe Negative (SECOND N0): Non-inferiority Phase III Trial
Assessment of the Effect of Tumor Thickness and Site on Level IV Cervical Lymph Nodes in Squamous Cell Carcinoma of the Tongue and Floor of the Mouth: A Case Series Study
Who cites it
38 citing papers in PubMed, 3 syntheses or guidelines pooled it, 120 citations in OpenAlex.
- The reporting of health systems data use in primary results publications of clinical trials: a systematic review.Trials · 2025Pooled it
- Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment.The Cochrane database of systematic reviews · 2023Pooled it
- Systematic review and meta-analysis of cervical metastases in oral maxillary squamous cell carcinoma.Cancer reports (Hoboken, N.J.) · 2021Pooled it
- Tumor-Regional Immune Microenvironment: A Critical Factor in the Design of Radiotherapy-Immunotherapy Combination Trials.International journal of cancer · 2026Review
- Implementation of ultrasound surveillance following negative sentinel lymph node biopsy in early oral squamous cell carcinoma: a retrospective cohort study.Oral and maxillofacial surgery · 2026Article
- Metastatic neck involvement in oral squamous cell carcinoma: A retrospective clinicopathological study.The Saudi dental journal · 2026Article
- Beyond sentinel node biopsy: preliminary results of indocyanine green-guided neck dissection in cN0 tongue cancer.Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale · 2026Article
- Evaluating differentiation grade as a guide for decision-making in elective neck dissection for early-stage oral squamous cell carcinoma: a population-based cohort study.Translational cancer research · 2026Article
- Evaluation of neoadjuvant immunotherapy regimens for head and neck squamous cell carcinoma: a systematic review and single-arm and network meta-analysis.International journal of surgery (London, England) · 2026Article
- Cost Analysis of Sentinel Lymph Node Biopsy for Oral Tongue Squamous Cell Carcinoma: Institutional Cohort and Population-Based Simulation.International archives of otorhinolaryngology · 2025Article
- When Neck Dissection is Not Indicated in the Treatment of the Clinically Node-Negative Head and Neck Squamous Cell Carcinoma.Oncology and therapy · 2025Article
- Historical milestones in the evolution of the procedure of neck dissection.World journal of otorhinolaryngology - head and neck surgery · 2024Review
- Occult Metastasis: Incidence, Pattern, and Impact on Survival in Patients with Oral Cancer, pN0 vs pN1 in a Cohort of cN0. A Prospective Cohort Study.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2024Article
- Management of Clinically Negative Neck in Early-Stage (T1-2N0) Oral Squamous-Cell Carcinoma (OSCC): Ten Years of a Single Institution's Experience.Journal of clinical medicine · 2024Article
- Review
- Survival among treated tongue cancer patients: a single-center experience.Discover oncology · 2024Article
- Occult metastasis is no burden factor in oral squamous cell carcinoma patients when adhering to a standardized approach in neck dissection.Clinical oral investigations · 2024Article
- Do patients with cN0 oral squamous cell carcinoma benefit from elective neck dissection? A large-scale population-based study.BMC oral health · 2024Article
- The role of unconventional lymph node metastasis in neck recurrence among patients with tongue cancer.Clinical oral investigations · 2023Article
- Review
Corrections and comments
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- Erratum issued
Authors and funding
36 authors at 20 institutions in 1 country.
Funding
Abstract
backgroundGuidelines remain unclear over whether patients with early stage oral cancer without overt neck disease benefit from upfront elective neck dissection (END), particularly those with the smallest tumours.
methodsWe conducted a randomised trial of patients with stage T1/T2 N0 disease, who had their mouth tumour resected either with or without END. Data were also collected from a concurrent cohort of patients who had their preferred surgery. Endpoints included overall survival (OS) and disease-free survival (DFS). We conducted a meta-analysis of all six randomised trials.
resultsTwo hundred fifty randomised and 346 observational cohort patients were studied (27 hospitals). Occult neck disease was found in 19.1% (T1) and 34.7% (T2) patients respectively. Five-year intention-to-treat hazard ratios (HR) were: OS HR = 0.71 (p = 0.18), and DFS HR = 0.66 (p = 0.04). Corresponding per-protocol results were: OS HR = 0.59 (p = 0.054), and DFS HR = 0.56 (p = 0.007). END was effective for small tumours. END patients experienced more facial/neck nerve damage; QoL was largely unaffected. The observational cohort supported the randomised findings. The meta-analysis produced HR OS 0.64 and DFS 0.54 (p < 0.001).
conclusionSEND and the cumulative evidence show that within a generalisable setting oral cancer patients who have an upfront END have a lower risk of death/recurrence, even with small tumours. CLINICAL
trial registrationNIHR UK Clinical Research Network database ID number: UKCRN 2069 (registered on 17/02/2006), ISCRTN number: 65018995, ClinicalTrials.gov Identifier: NCT00571883.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.