Aim. To share experience with regional failures after selective neck dissection in both node negative and positive previously untreated patients diagnosed with squamous cell carcinoma of the oral cavity. Patients and Methods. Data of 219 patients who underwent SND at Shaukat Khanum Cancer Hospital from 2003 to 2010 were retrospectively reviewed. Patient characteristics, treatment modalities, and regional failures were assessed. Expected 5-year regional control was calculated and prognostic factors were determined. Results. Median follow-up was 29 (9–109) months. Common sites were anterior tongue in 159 and buccal mucosa in 22 patients. Pathological nodal stage was N0 in 114, N1 in 32, N2b in 67, and N2c in 5 patients. Fourteen (6%) patients failed in clinically node negative neck while 8 (4%) failed in clinically node positive patients. Out of 22 total regional failures, primary tumor origin was from tongue in 16 (73%) patients. Expected 5-year regional control was 95% and 81% for N0 and N+ disease, respectively ( ). Only 13% patients with well differentiated, T1 tumors in cN0 neck were pathologically node positive. Conclusions. Selective neck dissection yields acceptable results for regional management of oral squamous cell carcinoma. Wait and see policy may be effective in a selected subgroup of patients. 1. Introduction Since description of neck dissection in late 19th century, modifications have been proposed, practiced, and argued. Tracing back the heritage of neck dissection, sequential evolution from a morbid to a cosmetically tailored and oncologically acceptable procedure becomes evident. Although several different classifications have been adapted in the past, debate on a balanced and widely acceptable nomenclature continues. Lately selective neck dissection (SND) has been the buzz word for regional management in head and neck cancer. Shah [1] demonstrated frequency and patterns of regional lymph node metastases from oral squamous cell carcinoma in patients who underwent radical neck dissection. By definition SND refers to preservation of 1 or more lymph node levels. Although SND is an accepted procedure for pathological staging of clinically node negative (cN0) neck, the house remains divided between elective neck dissection versus a more conservative wait and see policy [2]. The therapeutic role of SND in clinically node positive (cN+) disease is still unclear but is gaining popularity in carefully selected patients [3, 4]. The exact protocol for regional management of squamous cell carcinoma of oral cavity is yet to be established. The
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