Elective neck dissection in unilateral carcinomas of the tongue: Unilateral versus bilateral approach

Christopher Philipp Nobis, Sven Otto, Tamara Grigorieva, Mohamed Alnaqbi, Matthias Troeltzsch, Jakob Schöpe, Stefan Wagenpfeil, Michael Ehrenfeld, Klaus Dietrich Wolff, Marco Rainer Kesting

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10 Scopus citations

Abstract

Purpose Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent. Materials and methods A retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05). Results A total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures. Conclusion As both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and esthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.

Original languageEnglish
Pages (from-to)579-584
Number of pages6
JournalJournal of Cranio-Maxillofacial Surgery
Volume45
Issue number4
DOIs
StatePublished - 1 Apr 2017

Keywords

  • Elective neck dissection
  • Head and neck cancer
  • Oral and maxillofacial surgery
  • Oral tongue squamous cell carcinoma
  • Surgical oncology

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