Rhinology & Otology

Biography

Biography: Cyrus Kerawala

Abstract

The treatment of patients with early stage, clinically node-negative oral squamous cell carcinoma remains a contentious issue. The majority of patients treated with curative intent undergo surgical excision of the primary tumour. The neck is either electively treated at the time of ablation or subjected to watchful-waiting with therapeutic neck dissection for nodal relapse. Proponents of the elective approach site decreased relapse and better survival rates. Data from prospective trials provides conflicting advice. The watchful-waiting approach has the potential advantage of avoiding surgery in up to 70% of patients who are eventually found to be pathologically node-negative. In addition, neck dissection is associated with cost, be it morbidity to the patient or financial to the health system. Proponents of a watchful-waiting approach put forward an argument that metastases can be detected at an early stage during a proactive follow-up protocol and as such a patient’s outcome is ultimately not compromised. These conflicting opinions have led to variability in management throughout the world. This presentation aims to inform the audience regarding these controversies and delineate an approach to the clinically node-negative neck in early oral squamous cell carcinoma on the basis of evidence and health economics.