Elective Neck Dissection in Advanced Cutaneous Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta-Analysis.

Abstract

<h4>Objective</h4>The role of elective neck dissection (END) in clinically node negative (cN0) locally advanced cutaneous squamous cell carcinoma (cSCC) of the head and neck on survival outcomes is not well elucidated. To date, there is no systematic review performed on the role of END in cN0 disease for advanced cSCC. This study aims to determine if END affects survival outcomes compared to observation.<h4>Design</h4>Systematic review from inception to 22 June 2025 of three peer-reviewed databases (MEDLINE, Embase, Scopus), two clinical trial registries (Clinicaltrials.gov, ANZCTR) and grey literature (Scopus), for MeSH terms pertaining to 'elective neck dissection', 'cutaneous squamous cell carcinoma' and 'head and neck'. This review was registered prospectively on PROSPERO (CRD42024537410).<h4>Participants</h4>END in patients with cN0 locally advanced head and neck cSCC.<h4>Main outcome measures</h4>Overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS).<h4>Results</h4>Of 983 unique studies, 119 studies underwent full-text screening. Six studies underwent systematic review and meta-analysis. Of 522 included patients, 197 (37.7%) underwent END and 325 (62.3%) underwent observation. Six studies reported on OS, four studies on DSS and three on DFS. Meta-analysis for OS at 5 years did not provide a conclusion for or against END (log risk-ratio 0.09, 95% CI -0.57 to 0.76). Meta-analysis could not be performed for DSS. The meta-analysed occult cervical nodal rate was 17.34% (95% CI 10.57 to 25.14). Studies were of low to moderate risk of bias.<h4>Conclusion</h4>In locally advanced cSCC, END cannot be conclusively stated to improve OS or DSS.