Endoscopic versus open neck dissection for oral squamous cell carcinoma: a randomized controlled trial of surgical outcomes and short-term oncological safety
This randomized controlled trial demonstrates that endoscopic neck dissection via a retroauricular approach offers superior functional and aesthetic outcomes with reduced blood loss and shorter hospital stays compared to open neck dissection for oral squamous cell carcinoma, despite a transient early postoperative inflammatory response and longer operative time, while maintaining acceptable short-term oncological safety.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Cancer of the mouth, specifically a type called oral squamous cell carcinoma, remains a serious challenge for doctors and patients alike. When this disease is diagnosed, the standard treatment often involves surgery to remove the tumor and a careful cleaning of the lymph nodes in the neck to ensure no hidden cancer cells remain. For decades, the reliable way to do this cleaning has been a traditional open surgery, where a surgeon makes a visible cut along the front of the neck to access the area. While this method is effective at stopping the cancer, it leaves a noticeable scar and can cause significant stiffness or weakness in the shoulder and neck muscles as the body heals. In recent years, surgeons have begun exploring a different path: using a camera and long, thin instruments to perform the same cleaning through a hidden incision behind the ear. This approach promises to spare the patient a visible scar and perhaps a quicker recovery, but it raises a critical question: does this minimally invasive technique work just as well as the traditional method in fighting the disease, or does the hidden approach compromise the safety of the operation?
A team of researchers at Suining Central Hospital in China set out to answer this question with a direct comparison. They recruited sixty-four patients with early-stage oral cancer and randomly assigned them to one of two groups. Thirty-two patients received the traditional open neck dissection, while the other thirty-two underwent the endoscopic procedure through a hairline incision behind the ear. The goal was to see how the two methods compared in terms of the surgery itself, the recovery process, and the immediate safety regarding the cancer. The researchers tracked everything from how much blood was lost during the operation to how long patients stayed in the hospital, how their bodies reacted to the trauma of surgery, and how well their necks and shoulders functioned afterward. They also paid close attention to the cosmetic result, measuring the quality of the scars, and monitored the patients for a year to ensure the cancer did not return.
The results revealed a clear trade-off between the two approaches. The endoscopic surgery took longer to perform, averaging over eight and a half hours compared to just under seven hours for the open method. This extra time was due to the complexity of creating a working space behind the ear and maneuvering instruments under a camera. However, the benefits of the endoscopic approach were significant in other areas. Patients in the endoscopic group lost less blood during the surgery, required far less fluid drainage after the operation, and had their drainage tubes removed much sooner. Perhaps most notably, they were able to leave the hospital in about thirteen days, whereas those who had the open surgery stayed for nearly twenty-five days. The hidden incision also delivered on its promise of better aesthetics; the scars behind the ear were far less noticeable than the long cuts on the front of the neck, and patients reported better recovery of neck and shoulder function during the postoperative period.
Despite these physical advantages, the endoscopic method did trigger a stronger initial reaction from the body's immune system. In the days immediately following surgery, patients who had the endoscopic procedure showed higher levels of inflammation markers and stress proteins in their blood compared to the open surgery group. Their bodies were working harder to heal the internal tissues created by the endoscopic dissection. However, this difference was temporary. By the time one month had passed since discharge, the inflammation levels in both groups had settled down to the same point, suggesting that the body eventually recovered from the endoscopic approach just as well as from the traditional one.
When it came to the most important factor—fighting the cancer—both methods performed equally well in this study. Over the course of a year, among the patients with available follow-up data, no one in either group experienced a return of the cancer in the neck or elsewhere, and no one died from the disease. The surgeons were able to remove the necessary lymph nodes with the same thoroughness using the camera as they did with the open cut. The study did note a few minor differences in complications; for instance, a small number of patients in the endoscopic group felt numbness in their ears, while a couple of patients in the open group experienced a rare leak of fluid from the lymphatic system, but neither difference was statistically significant enough to declare one method unsafe.
This research suggests that for carefully selected patients with early-stage oral cancer, the endoscopic approach offers a viable alternative to the traditional open surgery. It provides a way to remove the cancer with the same effectiveness while significantly reducing the visible scar, shortening the hospital stay, and improving the patient's ability to move their neck and shoulder comfortably after the operation. The longer surgery time and the slightly more intense initial inflammatory response appear to be small prices to pay for these benefits, provided the surgery is performed by experienced surgeons. While the study was limited to a single hospital and a one-year follow-up, the findings offer a hopeful glimpse into a future where cancer treatment can be less invasive and more respectful of a patient's quality of life.
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