Elective neck dissection versus observation in the management of early tongue carcinoma with clinically node-negative neck: a retrospective study of 229 cases

J Craniomaxillofac Surg. 2014 Sep;42(6):806-10. doi: 10.1016/j.jcms.2013.11.016. Epub 2013 Nov 19.

Abstract

Background: The aim of the study is to evaluate the results of elective neck dissection (END) versus conservative management (observation) in the treatment of stages I and II squamous cell carcinoma of tongue.

Patients and methods: This is a retrospective study including 229 patients with surgical treatment between June 1993 and May 2010.

Results: There were 15 (9.6%) patients in the END group and 14 (19.2%) patients in the observation group who developed nodal recurrence alone without associated local recurrence or distant metastasis. Node-related mortality rate was 5.1% (8/156) for END and 12.3% (9/73) for observation. Further analysis for subgroups of stage T1 showed that the patients from END group had a better 5-year disease-specific survival (DSS) than those from the observation group in spite of no statistical difference (87.2% vs. 76.0%, Log-rank p = 0.282). END compared with observation for patients with stage T2 had a better 5-year DSS (74.2% vs. 41.2%, Log-rank p = 0.008).

Conclusions: Elective neck dissection significantly reduces mortality due to lymph nodal metastasis and also increases the 5-year DSS, most marked in patients with stage T2 OSCC. This retrospective study suggests that END should be a preferred treatment strategy for tongue carcinoma in stage T2.

Keywords: Elective neck dissection; Observation; Prognosis; Squamous cell carcinoma; Tongue.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / surgery*
  • Cohort Studies
  • Disease-Free Survival
  • Elective Surgical Procedures*
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis / pathology
  • Male
  • Middle Aged
  • Neck Dissection / methods*
  • Neoplasm Grading
  • Neoplasm Staging
  • Retrospective Studies
  • Survival Rate
  • Tongue Neoplasms / surgery*
  • Treatment Outcome
  • Watchful Waiting*
  • Young Adult