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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%.
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%.
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.
Shares Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Oral cavity cancer (mouth and tongue), New England Journal of Medicine.
Shares Buccal mucosa and gingivobuccal cancer (oral cancer in India), Oral cavity cancer (mouth and tongue), New England Journal of Medicine.
Shares Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Head and neck squamous cell carcinoma.
Shares Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Oral cavity cancer (mouth and tongue), Tata Memorial Centre.
Shares Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Oral cavity cancer (mouth and tongue), Sentinel lymph node biopsy.
Shares Buccal mucosa and gingivobuccal cancer (oral cancer in India), Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma.
Shares Anil K. D'Cruz, Head and neck squamous cell carcinoma.
Shares Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Oral cavity cancer (mouth and tongue).