Strength and limitations of the study
The strength of this meta-analysis is represented by its systematic and
quantitative assessment of the role of prophylactic neck dissections in
TBSCC using a strict inclusion and exclusion criteria. Our limitations
include the low number of cases reporting the level of metastasis in the
neck and the fact that the rates of occult nodal metastasis reported in
the literature could be underestimated as not all cN0 patients underwent
a neck dissection. From a statistical point of view, this meta-analysis
has the limitation of having only observational and retrospective
studies included. Furthermore, there are a relative low number of cases
in some of the studies predominantly as a result of the rarity of these
malignancies. Further limitations of our study include:
(a) Insufficient of data for a statistical analysis on the prevalence of
occult metastases in each of the different lymph node levels
b) Inability to determine whether selective neck dissection is better
than radiotherapy.
c) The inclusion criteria for many studies were not specified. This
resulted in the exclusion of 17 studies in the final phase of review.
It would be helpful to perform a prospective multicentre study to
compare the effectiveness of elective neck dissection and radiotherapy
in TBSCC cN0 necks as data from individual units are unlikely to be
sufficiently powered to influence overall management.