Conclusion
We have demonstrated that level II, III and IV neck dissection is the minimum number of levels required to be dissected for all patients undergoing primary surgery for p16+ve OPSCC. Supra-selective ipsilateral neck dissection in the primary surgical setting cannot be recommended due to the potential risk of undertreatment of occult disease in level IV. We also demonstrate that the cN0 neck at level II has a low negative predictive value for the absence of clinical nodal disease at level II, although the clinical utility of this is low.
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