Skip to main content
SpringerLink
Log in

Prevalence and Patterns of Nodal Metastasis Among Oral Cavity Cancer Patients: A Prospective Observational Study

  • Original Article
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Introduction

Lip and oral cavity cancer remains the most common cancer among Indian males and third most common cause of cancer-related deaths in India. Cervical lymph node metastasis is one of the most important prognostic factors in oral cavity cancer. The aim of present study was to estimate the prevalence of nodal involvement and analyse patterns of nodal metastasis in oral cavity cancer patients.

Methods

This prospective observational study was conducted between January 2019 and June 2020. Patients of oral cavity squamous cell carcinoma undergoing surgery with simultaneous neck dissection were included. Data pertaining to the clinical profile, treatment and histology details were collected and analysed.

Results

A total of 63 patients were included in present study. Out of 63 patients, unilateral neck dissection was performed in 47 (75%), while 16 (25%) underwent bilateral neck dissection. Overall clinical and pathological nodal positivity rates were 75% and 52%, respectively. Level I (48%) followed by IIa (20%) were most commonly involved stations. Combined involvement of level IV and V was seen in only 5%, and no skip metastasis was reported in level IV and V.

Conclusion

Level I and II are the most commonly involved stations in oral cavity squamous cell carcinoma (SCC). Oral SCC has a predictable nodal spread pattern with no skip metastasis to level IV/V noted in present study. There is a need for good quality randomised control trials to optimise the treatment protocols in clinically node-positive patients with respect to level IIB and V dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 356-india-fact-sheets.pdf. [cited 2021 May 1]. https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf

  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020 GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249

    Article  Google Scholar 

  3. D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R et al (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373(6):521–529

    Article  Google Scholar 

  4. Shah JP, Candela FC, Poddar AK (1990) The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer 66(1):109–113

    Article  CAS  Google Scholar 

  5. Ferlito A, Silver CE, Rinaldo A (2007) Neck dissection in the new era. J Am Coll Surg 204(3):466–468

    Article  Google Scholar 

  6. Byers RM, Wolf PF, Ballantyne AJ (1988) Rationale for elective modified neck dissection. Head Neck Surg 10(3):160–167

    Article  CAS  Google Scholar 

  7. Deo S, Singh V, Mokkapati PR, Shukla NK, Dwivedi SN, Sharma A et al (2020) Clinical spectrum, pattern, and level-wise nodal involvement among oral squamous cell carcinoma patients - audit of 945 oral cancer patient data. Indian J Surg Oncol 11(1):86–91

    Article  Google Scholar 

  8. Pantvaidya GH, Pal P, Vaidya AD, Pai PS, D’Cruz AK (2014) Prospective study of 583 neck dissections in oral cancers: implications for clinical practice. Head Neck 36(10):1503–1507

    Google Scholar 

  9. Shah JP (1990) Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 160(4):405–409

    Article  CAS  Google Scholar 

  10. Pantvaidya G, Rao K, D’Cruz A (2020) Management of the neck in oral cancers. Oral Oncol 100:104476

    Article  Google Scholar 

  11. Harish K (2005) Neck dissections: radical to conservative. World J Surgical Oncol 3(1):1–13

    Article  Google Scholar 

  12. Deo SVS, Shukla NK, Jha D, Khanna P, Pandit A, Thulkar S (2012) Are we over-treating neck in buccal & alveolo-buccal cancers: experience from a tertiary cancer care center. Indian J Surg Oncol 3(4):272–275

    Article  CAS  Google Scholar 

  13. Deo SV, Jakhetiya A, NML M, Sreenivas V, Thulkar S, Bhasker S, &, Sharma A (2018) Clinical spectrum, treatment and relapse patterns in 353 patients with squamous cell carcinoma of the alveobuccal complex treated with a curative intent: a retrospective study. J Maxillofac Oral Surg 17(1):24–31

    Article  Google Scholar 

  14. Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P (1997) Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck 19(1):14–19

    Article  CAS  Google Scholar 

  15. Woolgar JA (2007) The topography of cervical lymph node metastases revisited: the histological findings in 526 sides of neck dissection from 439 previously untreated patients. Int J Oral Maxillofac Surg 36(3):219–225

    Article  CAS  Google Scholar 

  16. Kapoor C, Vaidya S, Wadhwan V, Malik S (2015) Lymph node metastasis: a bearing on prognosis in squamous cell carcinoma. Indian J Cancer 52(3):417

    Article  CAS  Google Scholar 

  17. Warshavsky A, Rosen R, Nard-Carmel N, Abu-Ghanem S, Oestreicher-Kedem Y, Abergel A, Horowitz G (2019) Assessment of the rate of skip metastasis to neck level iv in patients with clinically node-negative neck oral cavity squamous cell carcinoma: a systematic review and meta-analysis. JAMA Otolaryngol-Head Neck Surg 145(6):542–548

    Article  Google Scholar 

  18. Feng Z, Li JN, Niu LX, Guo CB (2014) Supraomohyoid neck dissection in the management of oral squamous cell carcinoma: special consideration for skip metastases at level IV or V. J Oral Maxillofac Surg 72(6):1203–1211

    Article  Google Scholar 

  19. Lim YC, Koo BS, Lee JS, Choi EC (2006) Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: Is it absolutely necessary? Laryngoscope 116(7):1232–1235

    Article  Google Scholar 

  20. Bradley PJ, Ferlito A, Silver CE, Takes RP, Woolgar JA, Strojan P et al (2011) Neck treatment and shoulder morbidity: still a challenge. Head Neck 33(7):1060–1067

    Article  Google Scholar 

  21. Cappiello J, Piazza C, Giudice M, De Maria G, Nicolai P (2005) Shoulder disability after different selective neck dissections (levels II-IV versus levels II-V): a comparative study. Laryngoscope 115(2):259–263

    Article  Google Scholar 

  22. Lea J, Bachar G, Sawka AM, Lakra DC, Gilbert RW, Irish JC et al (2010) Metastases to level IIb in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis. Head Neck 32(2):184–190

    Google Scholar 

  23. Bhattacharya A, Adwani D, Adwani N, Sharma V (2015) Is it worthy? removal of level IIB nodes during selective neck dissection (I-III) for oral carcinomas. Ann Maxillofac Surg 5(1):20–25

    Article  Google Scholar 

  24. Pandey M, Karthikeyan S, Joshi D, Kumar M, Shukla M (2018) Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity. World J Surg Oncol 16(1):219

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Surgery, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Nilesh Mehta

  2. Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Ashish Jakhetiya

  3. MS Post Graduate, General Surgery, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Dev Patel

  4. Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Arun Pandey

  5. Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Tarang Patel

  6. Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Naveen Patidar

  7. General Surgery, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India

    Fateh singh Mehta

Authors
  1. Nilesh Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashish Jakhetiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dev Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arun Pandey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tarang Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naveen Patidar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fateh singh Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashish Jakhetiya.

Ethics declarations

Conflict of interest

They authors declare no conflict of interest.

Ethical standards

Institutional ethical committee clearance was obtained before enrollement.

Human and animals rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed written consent was obtained from all the participants. Complete anonymity is maintained for all included participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mehta, N., Jakhetiya, A., Patel, D. et al. Prevalence and Patterns of Nodal Metastasis Among Oral Cavity Cancer Patients: A Prospective Observational Study. J. Maxillofac. Oral Surg. 22, 245–251 (2023). https://doi.org/10.1007/s12663-022-01739-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-022-01739-w

Keywords

Search

Navigation