Luca Gazzini, Vittorio Rampinelli, Sarah Atallah, Aina Brunet, Leison Maharjan, Marco Zaraca, Ana Penezic, Olga Komiażyk, Pasquale D'Alessio, Samuel Oluyomi Ayodele, Andrea Galli, Eleonora Trecca, Matteo Di Bari, Çağrı Becerik, Laith Dahoun, Amaya Roldan Fidalgo, Dorota Świątek, Paula Pérez Chacón, Domenico Amadio, Nikola Đorđević, Carola Gillone, Hazan Basak, Magda Barańska, Diana Ugorova, Kylian Ladrière, Luca Giovanni Locatello, Federico Giuseppe Quarta, Katarzyna Fułek, Ismail S Nouh, Daniele Borsetto, Giulia Gobbo, Elisa Laura, Francesca Zanghi, Shalva Gvetazde, Y‐CEORL GROUP, Ignacio Javier Fernandez, Luca Calabrese, Virginia Dallari
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.
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.