TY - JOUR
T1 - Elective neck dissection in unilateral carcinomas of the tongue
T2 - Unilateral versus bilateral approach
AU - Nobis, Christopher Philipp
AU - Otto, Sven
AU - Grigorieva, Tamara
AU - Alnaqbi, Mohamed
AU - Troeltzsch, Matthias
AU - Schöpe, Jakob
AU - Wagenpfeil, Stefan
AU - Ehrenfeld, Michael
AU - Wolff, Klaus Dietrich
AU - Kesting, Marco Rainer
N1 - Publisher Copyright:
© 2017 European Association for Cranio-Maxillo-Facial Surgery
PY - 2017/4/1
Y1 - 2017/4/1
N2 - 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.
AB - 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.
KW - Elective neck dissection
KW - Head and neck cancer
KW - Oral and maxillofacial surgery
KW - Oral tongue squamous cell carcinoma
KW - Surgical oncology
UR - http://www.scopus.com/inward/record.url?scp=85012912335&partnerID=8YFLogxK
U2 - 10.1016/j.jcms.2017.01.008
DO - 10.1016/j.jcms.2017.01.008
M3 - Article
C2 - 28216228
AN - SCOPUS:85012912335
SN - 1010-5182
VL - 45
SP - 579
EP - 584
JO - Journal of Cranio-Maxillofacial Surgery
JF - Journal of Cranio-Maxillofacial Surgery
IS - 4
ER -