What do systematic reviews say?

PET-CT following chemoradiotherapy (neck dissection only if no/incomplete response) vs Planned neck dissection before or after chemoradiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: 22 surgical complications in the PET-CT group vs 83 in the planned-surgery group (Mehanna 2017).
  1 study · 564 participants
  Very low

Surgery vs Radiotherapy alone

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: grade 2+ treatment-related events similar (31/34 radiotherapy vs 33/34 surgery; RR 0.94, 0.83 to 1.06); more hearing loss/neutropenia/constipation/tinnitus with radiotherapy, more oral bleeding/trismus…
  1 study · 68 participants
  Very low

Elective neck dissection (at time of primary tumour resection) vs Therapeutic (delayed) neck dissection

Elective neck dissection (at time of primary tumour resection) probably leads to higher adverse events associated with treatment compared with therapeutic (delayed) neck dissection (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  RR 1.31 [1.11, 1.54]
  2 studies · 746 participants
  Moderate

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: no adverse events were reported (Garrel 2020).
  1 study · 279 participants
  Very low

Elective radical (comprehensive) neck dissection vs Elective selective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events (BHNCSG 1998): flap necrosis, wound infection, fistula, vascular rupture, haematoma, seroma, chyle fistula; no complications in 45/76 modified radical ND and 54/72 supraomohyoid ND; 2 vs 1 postoperative…
  1 study · 148 participants
  Low

Surgery plus radiotherapy vs Chemotherapy (chemoradiotherapy)

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: not reported for any participants (Iyer 2015).
  0 studies
  No studies found

Superselective neck dissection vs Elective selective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: no adverse events reported; 72 participants (2 RCTs).
  2 studies · 72 participants
  Very low

Supraomohyoid neck dissection vs Modified radical neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: significant difference in complication rates, lower for supraomohyoid (SOND 13.0% vs MRND 21.9%, P=0.040). UW-QOL at 1 year: supraomohyoid superior in pain relief (78.8% vs 75.2%, P=0.013) and shoulder…
  1 study · 332 participants
  Very low

Surgery plus radiotherapy vs Radiotherapy alone

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: severe acute effects in both groups (subcutaneous fibrosis, telangiectasia, moderate-to-severe oedema, xerostomia, trismus, dysphagia); subcutaneous fibrosis more prevalent with surgery + radiotherapy…
  1 study · 35 participants
  Very low