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Indian Journal of Surgical Oncology

, Volume 2, Issue 3, pp 172–175 | Cite as

To Operate or Not to Operate N0 Neck in Early Cancer of the Tongue? A Prospective Study

  • Manavalan Vijayakumar
  • Rajaram Burrah
  • K. S. Sabitha
  • Hoda Nadimul
  • B. C. Rajani
Original Article

Abstract

Squamous cell carcinoma (SCC) of the tongue is a common cancer across the globe. These cancers have a high predilection for nodal metastasis and a high incidence of occult metastasis. The management of clinically negative neck nodes (N0) remains controversial. We have undertaken a prospective study to evaluate the rate of occult nodal metastasis, the characteristic of metastasis, and assess the usefulness of tumor depth as a predictor of metastasis and as a guide to treat the neck. Prospective study between January 2000 to December 2005. Patients with SCC of the anterior 2/3rd of tongue with N0 neck were included. Wide excision of the primary and subsequent modified radical neck dissection (in patients with tumor depth > 4 mm) was performed. Postoperative radiotherapy was given in patients with lymph node metastasis. Patients who had no node metastasis (p N -ve) were observed. The total number of eligible patients was 180. Occult lymph node metastasis (p N +ve) was seen in 122 (62.2%) patients (p < 0.001), multiple levels of node involvement in 79 (70.5%) patients and extracapsular spread (ECS) in 38 (33.6%) patients. Patients in the p N +ve group who were disease free was 63.1% as compared to 68.2% in the p N -ve group (p = 0.36). Recurrence was seen in 28 (36.8%) patients of p N +ve group and 14 (31.8%) patients of p N -ve group. Early cancer of tongue with tumor depth >4 mm was associated with predominantly high grade tumors, high incidence of occult nodal metastasis, multiple levels of nodal involvement and ECS. The disease free status of patients with occult metastasis who were treated was similar to that of patients with no nodal metastasis. Elective neck dissection appears essential for early oral tongue cancer with tumor depth >4 mm as there is no investigational modality which can reliably identify patients without occult metastasis.

Keywords

Tongue cancer Elective neck dissection N0 neck Oral cancer 

Notes

Conflict of Interest

None.

References

  1. 1.
    Ho CM, Lam KH, Wei WI, Lau SK, Lam LK (1992) Occult lymph node metastasis in small oral tongue cancers. Head Neck 14:359–363PubMedCrossRefGoogle Scholar
  2. 2.
    Fakih AR, Rao RS, Patel AR (1989) Prophylactic neck dissection in squamous cell carcinoma of oral tongue: a prospective randomized study. Semin Surg Oncol 5:327–30PubMedCrossRefGoogle Scholar
  3. 3.
    Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW et al (2009) Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck 31(6):765–72PubMedCrossRefGoogle Scholar
  4. 4.
    Vandenbrouck C, Sancho-Garnier H, Chassagne D, Saravane D, Cachin Y, Micheau C (1980) Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial. Cancer 46:386–90PubMedCrossRefGoogle Scholar
  5. 5.
    Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ et al (1994) Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 168:391–4PubMedCrossRefGoogle Scholar
  6. 6.
    Andersen PE, Cambronero E, Shaha AR, Shah JP (1996) The extent of neck disease after regional failure during observation of the No neck. Am J Surg 172:689–691PubMedCrossRefGoogle Scholar
  7. 7.
    Shah J (1990) Cervical lymph node metastases: diagnostic, therapeutic, and prognostic implications. Oncology 4:61–69PubMedGoogle Scholar
  8. 8.
    Weiss MH, Harrison LB, Isaacs RS (1994) Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg 120:699–702PubMedCrossRefGoogle Scholar
  9. 9.
    D’Cruz AK, Siddachari RC, Walvekar RR, Pantvaidya GH, Chaukar DA, Deshpande MS et al (2009) Elective neck dissection for the management of the N0 neck in early cancer of the oral tongue: need for a randomized controlled trial. Head Neck 31(5):618–624PubMedCrossRefGoogle Scholar
  10. 10.
    van der Brekel MW, Castelijns JA, Stel HV, Golding RP, Meyer CJ, Snow GB (1993) Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol 250:11–7PubMedCrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2011

Authors and Affiliations

  • Manavalan Vijayakumar
    • 1
    • 2
  • Rajaram Burrah
    • 1
  • K. S. Sabitha
    • 1
  • Hoda Nadimul
    • 1
  • B. C. Rajani
    • 1
  1. 1.Department of Oral Oncology & Reconstructive ServicesKidwai Memorial Institute of OncologyBangaloreIndia
  2. 2.Department of Surgical OncologyKidwai Memorial Institute of OncologyBangaloreIndia

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