| Purpose:At present,whether patients with primary c N0 squamous cell carcinoma of the lip should undergo elective neck dissection at the same time is still controversial in the academic community.The purpose of this study was to compare the difference in the rate of neck metastasis in patients with primary c N0 squamous cell carcinoma of the lip after intraoperative elective neck dissection at the same time and not intraoperative elective neck dissection.Methods:Computer search Pub Med,Web of Science,Cochrane Library,Embase and CNKI,Wan Fang,A study of patients with primary c N0 squamous cell carcinoma of the lip undergoing intraoperative elective neck dissection at the same time compared with not intraoperative elective neck dissection from the establishment date of the database to December 31,2022.Data extraction and study quality assessment were conducted independently by two authors.The data to be extracted included:first author name,year of publication,study site,tumor site,tumor T stage,study sample size,patient diagnosis,disease-related survival rate,follow-up time,and number of neck metastases after two different operations.The outcome index of this meta-analysis was the rate of neck metastasis.Review Manager 5.3 software was used for statistical analysis of the data extraction results.Results:A total of 1077 patients with stage T1-T4 squamous cell carcinoma of the lip from 1990 to 2014 were included in this meta-analysis.All patients underwent extensive resection of the primary tumor.380 patients underwent intraoperative elective neck dissection at the same time and 697 patients not underwent intraoperative elective neck dissection at the same time.Patients were followed up for 2-10 years.The total number of patients with neck metastasis during follow-up in each study was extracted and counted.The results of meta-analysis showed that there was no significant difference in the rate of neck metastasis between patients with primary c N0 squamous cell carcinoma of the lip who underwent elective neck dissection at the same time and those who did not at the same time[OR=0.37,95%CI(0.10,1.39),P=0.14].Due to significant heterogeneity in each study(I~2=77%,P<0.0001),we excluded one study that was the main source of heterogeneity and conducted a separate meta-analysis.The results showed that[OR=0.64,95%CI(0.25,1.62),P=0.35],the results were not statistically significant.In addition,we conducted A subgroup analysis on the above 8 studies,and divided them into two groups,group A and Group B,based on whether all cases in the studies had stage T1-2 tumors.Group A was a study with stage T1-2 tumors in all cases.Group B was the study of stage T1-2 tumors not all cases.The results of group A showed:[OR=0.47,95%CI(0.14,1.54),P=0.21],and the results were not statistically significant.The results of group B showed:[OR=0.24,95%CI(0.01,5.40),P=0.37],the results were not statistically significant.Conclusion:In patients with primary c N0 squamous cell carcinoma of the lip at stage T1-2,there was no significant difference in the rate of neck metastasis between patients undergoing elective neck dissection at the same time and those not undergoing elective neck dissection at the same times.For patients with primary c N0 squamous cell carcinoma of the lip at stage T1-2,Lymph nodes that are not palpable or not visible by any diagnostic modalities in cases of primary squamous cell carcinoma of the lip may be left untreated,kept under close observation,and treated once metastasis develops.In the study group of patients with primary c N0 squamous cell carcinoma of the lip containing stage T3-4 tumor,although the results of meta-analysis showed that there was no statistically significant difference in the rate of neck metastasis after the two different operations,this was because the specific data on the rate of neck metastasis in the patients with different TNM stages in the included studies could not be known.In addition,the included studies accounted for a small proportion of patients with stage T3-4 tumors,so the evidence for the results of meta-analysis in this subgroup was not sufficient.Therefore,it is not possible to conclude that there is no significant difference in the rate of neck metastasis between the two different operations.Moreover,we found that the overall rate of neck metastasis and mortality increased in the study group of patients with primary c N0 squamous cell carcinoma of the lip with stage T3-4 tumor.We believe that we are in the process of obtaining more cases and detailed stratified data.That is,how many patients with single stage T3-4 tumor had neck metastasis.After excluding the interference of the data of patients with stage T1-2 tumor,the conclusion of different neck metastasis rates after two different operations will be drawn. |
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