Challenging the 20% Rule: Is a Fixed Cutoff Still Appropriate for Elective Neck Dissection in cN0 Necks?
Head and Neck, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1002/hed.70444
- Dergi Adı: Head and Neck
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: elective neck dissection, occult metastasis, quality of life, risk tolerance, survey
- Ankara Üniversitesi Adresli: Evet
Özet
Background: The 20% occult metastasis threshold proposed by Weiss in 1990 has long guided elective neck dissection (END) in clinically node-negative (cN0) head and neck cancer, despite advances in surgical safety and oncologic evidence. Methods: An international web-based cross-sectional survey evaluated acceptable risk thresholds and attitudes toward END among head and neck (HN) surgeons, other healthcare professionals, and non-healthcare participants. The primary outcome was the acceptable occult metastasis risk to justify END; secondary outcomes included acceptable 5-year mortality increase and complication trade-offs. Results: Of 2077 responses, 2008 were analyzed. Overall, 55% would undergo END at ≤ 10% occult metastasis risk and 86% at 20%. Responses differed significantly across groups (p < 0.0001), with lower thresholds among HN surgeons; 57% endorsed END at ≤ 10% and 92% at ≤ 20%. Among HN surgeons, a threshold of 5% or lower was considered sufficient to include the following levels in the dissection: 78% of surgeons for Level IIB, 75% for Level IV, and 69% for Level V. The majority of HN surgeons (90%) considered it more appropriate to calculate the individual risk and discuss the indication with the patient rather than relying on a fixed threshold. Conclusions: Most respondents—particularly HN surgeons—favor lower thresholds than the historical 20%, supporting individualized risk-based decision-making rather than reliance on a fixed cut-off.