{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:08:27Z","timestamp":1785902907845,"version":"3.56.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Elective neck dissection (END) for oral tongue squamous cell carcinoma (OTSCC) typically involves level 4 due to potential metastases that may bypass levels 1\u20132. Our study challenges this notion and investigates the necessity of level 4 inclusion in END for OTSCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study performed in a tertiary\u2010care university affiliated medical center and included all OTSCC patients treated with END from 2000 to 2020, with a minimum 2\u2010year follow\u2010up. The study compared patients with END levels 1\u20133 to those with levels 1\u20134 regarding regional recurrence, disease\u2010specific and disease\u2010free survival rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      120 patients with OTSCC and clinically negative neck were included. END included levels 1\u20134 in 33 patients (27.5%) and levels 1\u20133 in the remaining 87 patients (72.5%). Out of all 33 patients who underwent END of levels 1\u20134, only 1 patient had level 4 metastasis (3%). There was no significant difference in the regional recurrence rate (21.8% vs. 18.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.66) and level 4 recurrence rate (3.5% vs. 3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.91) between the groups. No difference regarding 5\u2010years overall, disease\u2010specific, and disease\u2010free survival was demonstrated between the 1\u20133 END and 1\u20134 END groups (69.3% vs. 61.1%, Log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.7, 82% vs. 66.2%, Log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.15% and 66.4% vs. 60.7%, Log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.54, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Inclusion of level 4 in the elective neck dissection for OTSCC does not seem to improve regional control, disease\u2010free and overall survival. Hence, elective neck dissection of levels 1\u20133 seems appropriate for most cases of OTSCC, as for other oral cavity subsites.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70191","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T07:26:16Z","timestamp":1768375576000},"page":"459-464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Prognostic Significance of Elective Level 4 Neck Dissection in Oral Tongue Cancer"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8211-9774","authenticated-orcid":false,"given":"Eyal","family":"Yosefof","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Institute of Oncology, Davidoff Center, Rabin Medical Center Petach Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nofar","family":"Edri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Ritter","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lior","family":"Gendlin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuval","family":"Avidor","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Bachar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Shpitzer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Rabin Medical Center Petah Tikva Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aviram","family":"Mizrachi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery, Weill Cornell Medical College Cornell University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2009.11.016"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-009-0894-6"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29674"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.104476"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506007"},{"key":"e_1_2_11_7_1","unstructured":"National Comprehensive Cancer Network. Head and Neck Cancer (Version 2.2024) accessed on 17 January 2024 https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/head-and-neck.pdf."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097-0347(199701)19:1<14::aid-hed3>3.0.co;2-y"},{"key":"e_1_2_11_9_1","unstructured":"R. O.Wein(2021). Malignant Neoplasms of the Oral Cavity. In Cummings otolaryngology: Head and Neck Surgery (pp.1304). essay Elsevier."},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2020.04.810"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2019.0784"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.1281"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2011.03.009"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006205.pub4"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27627"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19900701)66:1<109::aid-cncr2820660120>3.0.co;2-a"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70191","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70191","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T18:00:32Z","timestamp":1773597632000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/jso.70191"],"URL":"https:\/\/doi.org\/10.1002\/jso.70191","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"2025-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}