DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20194938

Limited neck dissection: is it enough in early oral tongue cancer? Retrospective study

Subbiah Shanmugam, Prem Kishore

Abstract


Background: The objective of the present study was to analyze the outcome of clinically node-negative early oral tongue cancer after selective neck dissection (SND) versus conventional neck dissection (CND).

Methods: A total of 116 patients of early oral tongue cancer underwent neck dissection either SND or CND between 1st January 2013 to 31st December 2016 at Government Royapettah Hospital, Chennai, a tertiary level cancer center. For patients with pN0 after SND had no further procedure while for those with cN1 disease, CND was done as a standard procedure. Comparison between the cN0 nodes to pN1 conversion rates in SND group with cN1 to pN0 rates in CND group was done along with the morbidity rates. The clinicopathological parameters along with intraoperative and postoperative parameter relevant to recurrence were analyzed by univariant and multivariant analysis and both the groups were compared by Chi-square test (SPSS version 26.0).  

Results: In the SND group, pN1 were 2/53 (3.77%) and in the CND group pN1 was 11/63 (17.46%). Mean Nodal retrieval in SND group was 18.96 nodes and in CND group 22.90 nodes per case. Regional nodal recurrences in the SND group were 8/53 (15.81%) and in the CND group was 9/63 (14.28%). Our study shows no significant statistical difference between nodal recurrences in CND and SND group.

Conclusions: Our study data suggests that for cN1 patients, SND may be optimal and early tongue cancer patients with cN0 could be candidates for an SND instead of CND.


Keywords


Selective neck dissection, Comprehensive neck dissection, Clinically nonpalpable neck node, Clinically palpable neck node, Pathological negative node, Pathological positive node

Full Text:

PDF

References


Hamoir M, Silver CE, Schmitz S, Takes RP, Rinaldo A, Rodrigo JP, et al. Radical neck dissection: is it still indicated?. Eur Arch Otorhinolaryngol. 2013;270:1-4.

Woolgar JA, Rogers S, West CR, Errington RD, Brown JS, Vaughan ED. Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. Oral Oncol. 1999;35(3):257-65.

Ferlito A, Rinaldo A. Is radical neck dissection a current option for neck disease?. Laryngoscope. 2008;118:1717-8.

Coskun HH, Medina JE, Robbins KT, Silver CE, Strojan P, Teymoortash A, et al. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma. Head Neck. 2015;37:915-26.

Crile G. Excision of cancer of the head and neck- with special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA. 1906;47:1780.

Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, et al. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010;28:1395-400.

Buckley J, Feber T. Surgical treatment of cervical node metastases from squamous carcinoma of the upper aerodigestive tract: evaluation of the evidence for modifications of neck dissection. Head Neck. 2001;23:915.

Shah J. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990;160:405.

Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB, et al. Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: Patterns of regional failure. Head Neck. 1999;21:499-505.

Spiro RH, Morgan GJ, Strong EW, Shah JP. Supraomohyoid neck dissection. Am J Surg. 1996;172(6):650-3.

Bessell A, Glenny AM, Furness S, Clarkson JE, Oliver R, Conway DI, et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev. 2011;9:CD006205.

Feng Z, Gao Y, Niu LX, Peng X, Guo CB. Selective versus comprehensive neck dissection in the treatment of patients with a pathologically node-positive neck with or without microscopic extracapsular spread in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2014;43:1182-8.

Bradley PJ, Ferlito A, Silver CE, Takes RP, Woolgar JA, Strojan P, et al. Neck treatment and shoulder morbidity: still a challenge. Head Neck. 2011;33:1060-7.

Gane EM, Michaleff ZA, Cottrell MA, McPhail SM, Hatton AL, Panizza BJ, et al. Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review. Eur J Surg Oncol. 2017;43:1199-218.

Van Wouwe M, de Bree R, Kuik DJ, de Goede CJ, de Leeuw VIM, Doornaert P, et al. Shoulder morbidity after non-surgical treatment of the neck. Radiother Oncol. 2009;90:196-201.