{"entity":{"id":"paper-dcruz-elective-neck-dissection-nejm-2015","kind":"paper","name":"Elective versus therapeutic neck dissection in node-negative oral cancer","aka":[],"tldr":"Removing the neck lymph nodes at the first operation for early mouth cancer, rather than waiting to see if they become involved, raised three-year survival from 67.5% to 80%.","summary":"Randomised trial at Tata Memorial Hospital of 596 patients with early (T1-T2) node-negative oral squamous cell cancer, 500 analysed (245 elective, 255 therapeutic neck dissection), median follow-up 39 months. Elective dissection gave 81 recurrences and 50 deaths versus 146 and 79; 3-year overall survival 80.0% versus 67.5% (hazard ratio 0.64; 95% CI 0.45-0.92; P=0.01) and disease-free survival 69.5% versus 45.9% (P<0.001); adverse events 6.6% versus 3.6%.","asOf":"2026-09-10","links":[{"label":"NEJM 2015","url":"https://doi.org/10.1056/NEJMoa1506007"}],"tags":[],"related":[],"cancers":["head-and-neck"],"sections":[],"technologies":["sentinel-node"],"targets":[],"drugs":[],"companies":[],"institutions":["tata-memorial"],"pathways":[],"terms":[],"trials":["elective-neck-dissection-tmh"],"people":["dcruz-anil"],"bottlenecks":["b-surgery-radiation-innovation"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2015,"doi":"10.1056/NEJMoa1506007","authors":"D'Cruz AK, Vaish R, Kapre N, et al.","paperType":"rct","findings":["3-year overall survival 80.0% with elective neck dissection versus 67.5% with watchful waiting (HR 0.64).","3-year disease-free survival 69.5% versus 45.9%.","Recurrences 81 versus 146; deaths 50 versus 79.","Adverse events were higher with elective dissection (6.6% versus 3.6%) but modest."],"whatItMeans":"Elective neck dissection is now the standard for early oral cancer everywhere. The trial shows what high-volume Indian centres can contribute: a definitive answer to a surgical question that had been debated for half a century and that Western centres, with far fewer oral cancers, could not resolve.","caveats":["Ultrasound and clinical staging of the neck were used; modern imaging or sentinel node biopsy may change the trade-off.","Single-centre trial in a predominantly tobacco-related oral cancer population.","Quality of life and morbidity outcomes were secondary."],"changedPractice":true,"participants":596},"route":"/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/","neighbours":{"cancer":[{"id":"buccal-mucosa-cancer","kind":"cancer","name":"Buccal mucosa and gingivobuccal cancer (oral cancer in India)","route":"/cancers/buccal-mucosa-cancer/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","route":"/cancers/oral-cavity-cancer/"},{"id":"oral-tongue-cancer","kind":"cancer","name":"Oral tongue and floor of mouth cancer","route":"/cancers/oral-tongue-cancer/"}],"technology":[{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"}],"institution":[{"id":"tata-memorial","kind":"institution","name":"Tata Memorial Centre","route":"/institutions/tata-memorial/"}],"trial":[{"id":"elective-neck-dissection-tmh","kind":"trial","name":"Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)","route":"/trials/elective-neck-dissection-tmh/"}],"person":[{"id":"dcruz-anil","kind":"person","name":"Anil K. D'Cruz","route":"/people/dcruz-anil/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}