Elective neck dissection in clinically early stage (cT1-T2N0) supraglottic squamous cell carcinomas: a systematic review

Background Early-stage supraglottic squamous cell carcinoma carries a substantial risk of occult lymph node metastasis, yet the benefit and extent of elective neck dissection (END) in clinically node-negative (cN0) patients remain debated. Methods This systematic review analyzed studies published between 2000 and 2025 evaluating END versus observation in adults with early-stage (cT1-T2N0) supraglottic tumors, following predefined criteria and PRISMA methodology. Results Sixteen studies met inclusion criteria. Occult nodal metastasis was identified in 13–37.5% of patients, with level II—especially sublevel IIA—representing the predominant site of disease (75–85%). In contrast, involvement of levels I, sublevel IIB, IV, and V was rare (<5%). Super-selective dissection limited to levels II–III (or sublevel IIA– level III) improved regional control compared with observation, although overall survival benefits were inconsistent across studies and often diminished after multivariable adjustment. Population-based analyses suggested a potential survival advantage with END, while institutional series reported variable outcomes. Factors associated with higher risk of occult metastasis included T2 classification, poor differentiation, and involvement of epilaryngeal structures such as the suprahyoid epiglottis, aryepiglottic folds, and arytenoids. Conclusions END detects clinically occult disease in up to one-third of patients and enhances regional control. Level-II–III dissection appears adequate for lateralized tumors, permitting omission of level IV and sublevel IIB, while midline lesions may require bilateral neck management. Given the uncertain survival advantage, a risk-adapted approach is recommended, reserving END for patients with high-risk features and considering close surveillance for carefully selected low-risk individuals.