ArticleJournal of surgical oncology2026
The Prognostic Significance of Elective Level 4 Neck Dissection in Oral Tongue Cancer.
Article in Journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionElective neck dissection (END) for oral tongue squamous cell carcinoma (OTSCC) typically involves level 4 due to potential metastases that may bypass levels 1-2. Our study challenges this notion and investigates the necessity of level 4 inclusion in END for OTSCC.
methodsA retrospective cohort study performed in a tertiary-care university affiliated medical center and included all OTSCC patients treated with END from 2000 to 2020, with a minimum 2-year follow-up. The study compared patients with END levels 1-3 to those with levels 1-4 regarding regional recurrence, disease-specific and disease-free survival rates.
results120 patients with OTSCC and clinically negative neck were included. END included levels 1-4 in 33 patients (27.5%) and levels 1-3 in the remaining 87 patients (72.5%). Out of all 33 patients who underwent END of levels 1-4, only 1 patient had level 4 metastasis (3%). There was no significant difference in the regional recurrence rate (21.8% vs. 18.2%, p = 0.66) and level 4 recurrence rate (3.5% vs. 3%, p = 0.91) between the groups. No difference regarding 5-years overall, disease-specific, and disease-free survival was demonstrated between the 1-3 END and 1-4 END groups (69.3% vs. 61.1%, Log-rank p = 0.7, 82% vs. 66.2%, Log-rank p = 0.15% and 66.4% vs. 60.7%, Log-rank p = 0.54, respectively).
conclusionInclusion of level 4 in the elective neck dissection for OTSCC does not seem to improve regional control, disease-free and overall survival. Hence, elective neck dissection of levels 1-3 seems appropriate for most cases of OTSCC, as for other oral cavity subsites.
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