Endoscopic versus open neck dissection for oral squamous cell carcinoma: a randomized controlled trial of surgical outcomes and short-term oncological safety

Abstract Objective To compare clinical outcomes of endoscopic neck dissection (END) via a retroauricular hairline approach with conventional open neck dissection (OND) in patients with oral squamous cell carcinoma (OSCC). Methods This single-centre randomised controlled trial included 64 patients with OSCC treated between January 2024 and September 2025. Patients were randomly assigned to the END or OND group, with 32 patients in each group. Perioperative outcomes, inflammatory responses, postoperative complications, neck and shoulder function, scar outcomes, and 12-month oncological outcomes were compared. Results Baseline characteristics were comparable between groups. Compared with OND, END required a longer operative time but was associated with less intraoperative blood loss, lower postoperative drainage volume, shorter drainage duration, and shorter hospital stay. From postoperative day 1 to the day before discharge, the END group showed higher levels of hematological inflammatory markers and inflammatory cytokines and lower albumin levels than the OND group. These intergroup differences were no longer significant at 1 month after discharge. Patients in the END group had better neck and shoulder function and more favorable scar outcomes. Postoperative complication rates were low in both groups. Among patients with available follow-up data, no local recurrence, metastasis, or death occurred within 12 months. Conclusion In selected patients with OSCC, END was associated with less intraoperative blood loss, reduced postoperative drainage, shorter drainage duration and hospital stay, and improved functional and aesthetic outcomes, although it was accompanied by a more pronounced early postoperative inflammatory response. These inflammatory differences were transient and were no longer evident at 1 month after discharge. END demonstrated acceptable short-term oncological outcomes in this selected cohort.