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Patients with locally advanced HPV-positive tonsil cancer would benefit from prophylactic contralateral neck dissection (pCND). The aim of this study was to analyze rates of contralateral lymph node metastases (LNM) and their prognostic effects on locally advanced HPV-positive tonsillar squamous cell carcinoma. Medical records of 54 patients who underwent upfront primary surgery and pCND were retrospectively reviewed. Six (11.1%) patients had contralateral LNM in 54 locally advanced HPV-positive tonsil cancer. Of these, five patients had contralateral level II LNM and one patient had contralateral level II and III LNM. Contralateral LNM showed significant positive correlations with advanced T stage ( p  = .017) and the presence of extracapsular spread ( p  = .007). Contralateral lymph node metastasis had no significant association with five-year disease-specific survival. This study demonstrated no advantage in performing pCND in early stage HPV-positive tonsil cancer.

Prophylactic contralateral neck dissection has no advantage in patients with early stage HPV-positive tonsil cancer