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. 2025 Apr 16:15:1483921.
doi: 10.3389/fonc.2025.1483921. eCollection 2025.

Algorithm-based analysis of lymph node dissection strategies and survival outcomes in primary oral squamous cell carcinoma

Andreas Vollmer #  1 , Babak Saravi #  2 , Alexander Kübler  1 , Urs Müller-Richter  1 , Anna Winter  3 , Simon Nagler  1 , Marius Hörner  1 , Sebastian Gubik  1 , Stefan Hartmann  1
Affiliations

Algorithm-based analysis of lymph node dissection strategies and survival outcomes in primary oral squamous cell carcinoma

Andreas Vollmer et al. Front Oncol. .

Abstract

Introduction: Recent advancements in treatment approaches for oral squamous cell carcinomas (OSCCs) necessitate a reevaluation of neck dissection techniques and their impact on patient outcomes and morbidity.

Methods: This retrospective study of 250 OSCC patients recruited between 2017-2022 examined the association between neck dissection techniques and survival metrics. Our cohort, drawn from a primary OSCC surgery population at our clinic, provided a rich dataset encompassing demographics, clinical parameters, and detailed surgical records. Two neck dissection techniques were analyzed: the Supraomohyoid Selective Neck Dissection (SND), which targets lymph nodes at Levels I-III, and Other Dissections (OD), which involve a more extensive extraction including Levels IV and V. Kaplan-Meier survival curves and Cox proportional hazards models assessed the influence of lymph node dissection on postoperative outcomes.

Results: Findings indicated that each additional lymph node removed was associated with a 0.289-day increase in hospitalization (p = 0.002), yet no significant link was found between dissection techniques or total lymph node extraction count and survival metrics. Levels I to III emerged as critical areas with the highest likelihood of yielding tumor-positive lymph nodes, emphasizing the significance of these levels.

Discussion: The study suggests that more extensive dissection does not necessarily confer survival benefits, highlighting the importance of strategic surgical focus and the potential for tailored interventions that prioritize disease-specific lymph node levels to optimize patient recovery and prognosis.

Keywords: Kaplan-Meier estimate; head and neck neoplasms; lymph node yield; neck dissection; proportional hazards model; survival rate.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Analysis of Lymph Node Extractions by Level. This figure displays the average numbers extracted and found positive, and the positivity ratios for each anatomical level (I to V). Graphs illustrate the extent of node extraction and cancer involvement across levels, with Level I showing the highest positivity ratio, indicating a greater incidence of cancer positivity relative to nodes examined.
Figure 2
Figure 2
Trends in total number of extracted lymph nodes for each anatomical level (I to V) between 2017-2022 normalized by number of patients.
Figure 3
Figure 3
Kaplan-Meier survival analysis for overall survival and recurrence-free survival.
Figure 4
Figure 4
Kaplan-Meier survival analysis for overall survival and recurrence-free survival stratified by lymph node dissection type.
See this image and copyright information in PMC

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