The Indications for Elective Neck Dissection in T1N0M0 Oral Cavity Squamous Cell Carcinoma.

PURPOSE: The management of the clinically node-negative neck in T1 oral cavity squamous cell carcinoma (SCC) is controversial. The purpose of this study was to investigate tumor characteristics of surgically managed patients with T1N0 oral cavity SCC and determine the possible benefits of elective neck dissection (END). MATERIALS AND METHODS: A retrospective cohort study was conducted assessing outcomes for patients with stage I oral SCC at Waikato Hospital, New Zealand, between 2008 and 2018. Clinical staging was based on the American Joint Committee on Cancer Cancer Staging Manual, 8th Edition. Patients with T1N0 SCC either had an END or had the neck observed. These data were used to determine the rate of occult nodal disease, recurrence rate, and survival. Data collected included patient demographics, location, tumor characteristics including differentiation, depth of invasion (DOI), perineural invasion (PNI), lymphovascular invasion, closest histologic margin, management of the neck, the number of pathologic lymph nodes, adjuvant treatment, recurrence, and survival. RESULTS: A total of 70 patients were included in the study (40 male, 30 female; age range 30 to 91; mean age 65 years). Twenty-seven (38.6%) patients underwent END, whereas 43 patients (61.4%) were observed. Occult nodal metastases were diagnosed in 6 of 27 (22.2%) patients who underwent END. Regional relapse occurred in 7 of 43 (16.3%) patients who were observed. Risk factors for nodal disease included increasing DOI ≥ 3 mm (P = .049), poor tumor differentiation (P = .003), and presence of PNI (P = .002). Negative prognostic factors for overall survival included male gender (P = .02, hr = 3.55, CI for HR (1.18, 10.65)), presence of PNI (P = .001, hr = 4.52, CI for HR (1.77, 11.57)), and locoregional recurrence (P < .005, hr = 6.55, CI for HR (2.69, 15.98)). Six of the 7 tumors that relapsed in the neck after observation had a primary tumor DOI < 3 mm. CONCLUSIONS: There is little data published for management outcomes of the node-negative neck in stage I oral squamous cell carcinoma. Given salvage neck dissection carries a poorer prognosis, END should be recommended for all T1N0 oral SCC with DOI ≥ 3 mm. In cases of DOI < 3 mm undergoing primary ablation only, a staging neck dissection as a second procedure should be considered in the presence of poor tumor differentiation or PNI on final histology.

The New Zealand oral and maxillofacial surgeon workforce in 2017-18: characteristics, practice and prospects.

AIM: To describe and consider the findings of a workforce survey of New Zealand Oral and Maxillofacial Surgeons (OMS) which was conducted in 2017-18, and to compare those to findings from a similar survey undertaken in 2001. METHODS: A questionnaire was used to obtain information on the qualifications, sociodemographic characteristics and and practising circumstances of all practising OMS in New Zealand. Data were analysed using SPSS (version 24). After the computation of descriptive statistics, cross-tabulations were used to identify differences in proportions (with those tested for statistical significance using Chi-squared tests), and analysis of variance was used to examine differences in means. RESULTS: All 39 OMS took part. There were 17 medically qualified surgeons who also held a surgical fellowship, comprising just under half of the workforce. Overall, one in eight surgeons worked solely in the public sector, while just under one-quarter worked solely in private; the remainder worked in both sectors. Dentoalveolar procedures were by far the most common undertaken (with considerably more done by older surgeons than younger ones), followed by implants, the treatment of facial trauma, skin lesions and surgery for malignancy. Orthognathic surgery and dentoalveolar trauma procedures were the least commonly reported. Only two-thirds of surgeons participated in public on-call work. While 95% of surgeons were indeed satisfied with their work, the lowest rate was observed among those working solely in the public sector, where it was 80%; among those working exclusively in private, it was 100%. Between 2001 and 2017-18, the proportion of medically qualified surgeons rose from just over one-quarter to more than two-thirds. The proportion of surgeons working solely in private practice rose from one in seven to almost one-quarter. There were marked increases in the mean number of malignancies dealt with and implants provided. CONCLUSION: The findings highlight a number of problems-some long-standing, others emerging-in New Zealand's OMS system. Fewer surgeons are participating in public sector provision and there is stress on those who remain. Workforce planners should be aware that more resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.