Incidence of Contralateral Neck Nodal Metastasis in Recurrent Oral Cavity Squamous Cell Carcinoma

Aim: The aim of the study was to evaluate the incidence of contralateral neck nodal metastasis in recurrent oral cavity squamous cell carcinoma (OCSCC) with ipsilateral neck addressed during previous surgery. Methodology: A retrospective analysis of prospectively collected data of 2870 patients treated at Kailash Cancer Hospital and Research Center, Goraj, from January 2018 to December 2022 was done. Ninety patients with ipsilateral local recurrences with lesions not crossing or reaching midline were evaluated for contralateral neck nodal metastasis. All patients had undergone ipsilateral neck dissection during the previous surgery. Results: Contralateral nodal metastasis was found in 16 patients (17.77%), of which 13 patients (14.44%) had extranodal extension (ENE) and 7 patients (7.77%) had occult metastasis. In 35 patients, ipsilateral completion neck dissection was performed, of which 5 patients (14.28%) were node positive with ENE and 8.33% had bilateral node positivity with ENE. The factors influencing contralateral nodal metastasis after surgery for recurrence were the depth of invasion and ipsilateral neck nodal positivity and factors influencing contralateral node positivity from the previous surgery were nodal status and margins. Conclusion: In patients with local recurrence of oral cavity squamous cell carcinoma, with ipsilateral neck addressed previously, the lymphatic patterns alter. Hence, the predictable echelons are modified and no longer reliable. Hence, along with the excision of the primary lesion, completion of the ipsilateral neck and addressing the contralateral neck becomes mandatory, even if the patient is clinically node negative.