Summary of findings 2. Elective radical neck dissection versus elective selective neck dissection.
| Radical neck dissection versus selective neck dissection | ||||||
|
Patient: adults with oral or oropharyngeal cancer Setting: inpatient Intervention: elective radical neck dissection Comparison: elective selective neck dissection | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Selective neck dissection | Radical neck dissection | |||||
| Total mortality | — | — | — | 252 (2) | ⊕⊝⊝⊝ Very lowa,b |
HR from 2 trials, but unable to pool data as different surgical procedures. Neither trial indicated that mortality was different for the 2 interventions. |
|
New disease, progression or mortality (follow‐up: 5 years) |
500c per 1000 | 326 per 1000 (182 to 537) |
HR 0.57 (0.29 to 1.11) |
104 (1) | ⊕⊝⊝⊝ Very lowb,d | These data were from the HR for disease‐free survival. 1 study, indicating no difference between the interventions. |
| 250c per 1000 | 151 per 1000 (80 to 273) | |||||
| Locoregional recurrence | — | — | — | — | — | Not reported |
|
Recurrence (5 years) |
180e per 1000 | 213 per 1000 (118 to 370) |
RR 1.21 (0.63 to 2.33) |
143 (1) | ⊕⊝⊝⊝ Very lowb,f,g | 1 study, indicating no difference between the interventions. |
| Adverse events | 1 trial reported the following adverse effects: flap necrosis, wound infection, fistula, vascular rupture, haematoma, seroma and chyle fistula. There were 0 complications in 45 participants (59%) in the modified radical neck dissection group and 0 in 54 participants (75%) in the supraomohyoid neck dissection group. There were 2 postoperative deaths in the modified radical neck dissection group and 1 in the supraomohyoid neck dissection group. The other studies did not report adverse events | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded twice, two heterogeneous studies at unclear and high risk of bias.
bDowngraded once for imprecision.
cPurely illustrative, unable to find any epidemiological estimates.
dDowngraded twice as single study at high risk of bias.
eEstimated from BHNCSG 1998.
fSDowngraded once as single study at unclear risk of bias.
g Downgraded twice for imprecision