Oral and Maxillofacial Surgery

, Volume 22, Issue 2, pp 185–192 | Cite as

Patients with unilateral squamous cell carcinoma of the tongue and ipsilateral lymph node metastasis do not profit from bilateral neck dissection

  • Christoph Klingelhöffer
  • Andreas Gründlinger
  • Gerrit Spanier
  • Stephan Schreml
  • Maximilian Gottsauner
  • Steffen Mueller
  • Johannes K. Meier
  • Torsten E. Reichert
  • Tobias Ettl
Original Article



The purpose of this study was to evaluate the necessity of elective bilateral neck dissection for treating strict unilateral squamous cell carcinoma (SCC) of the tongue.


A cohort of 169 patients with unilateral non-midline crossing SCCs of the tongue treated by local resection and neck dissection was investigated. Study endpoints were nodal relapse and overall survival. The mean follow-up was 7.4 years.


A total of 146 (88.1%) patients were treated by neck dissection. Lymph node metastases were diagnosed in 50 (34.2%) patients. Only two (1.1%) had contralateral lymph node metastases. Risk factors for developing a primary lymph node metastasis were size of tumor (T2/T3, p = 0.03; OR = 2.2), lymphangiosis (p = 0.003; OR = 4.7), and higher-grade differentiation (p = 0.051; OR = 2.43). Metachronous lymph node metastases were detected in 23 (13.6%) patients (19 ipsilateral, one contralateral and three bilateral). The main risk factor for developing a metachronous lymph node metastasis was the presence of a primary lymph node metastasis (p = 0.004; HR = 4.65). Patients with initial neck dissection came up with lower 5-year recurrence rates (13.6%) compared to patients without neck dissection (27.3%; p = 0.014). Bilateral neck dissection showed no advantage regarding nodal relapse free and overall survival (p = 0.606) compared to unilateral neck dissection irrespective of initial N or T stage.


Patients with unilateral SCC of the tongue benefit from an ipsilateral neck dissection regarding nodal relapse. The value of elective bilateral neck dissection as standard treatment seems questionable even if positive lymph nodes were diagnosed ipsilateral at primary therapy.


Oral tongue squamous cell carcinoma Elective neck dissection Bilateral Ipsilateral Oral cancer Head and neck cancer 


Compliance with ethical standards

This study was not funded. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been approved by the appropriate Ethical Committee (17-TEMP186882-104).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10006_2018_690_MOESM1_ESM.docx (19 kb)
Table S1 (DOCX 18 kb)


  1. 1.
    D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, Agarwal JP, Pantvaidya G, Chaukar D, Deshmukh A, Kane S, Arya S, Ghosh-Laskar S, Chaturvedi P, Pai P, Nair S, Nair D, Badwe R, Head, Neck Disease Management G (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373(6):521–529. CrossRefPubMedGoogle Scholar
  2. 2.
    Ren ZH, Xu JL, Li B, Fan TF, Ji T, Zhang CP (2015) Elective versus therapeutic neck dissection in node-negative oral cancer: evidence from five randomized controlled trials. Oral Oncol 51(11):976–981. CrossRefPubMedGoogle Scholar
  3. 3.
    Orabona GD, Bonavolonta P, Maglitto F, Friscia M, Iaconetta G, Califano L (2016) Neck dissection versus “watchful-waiting” in early squamous cell carcinoma of the tongue our experience on 127 cases. Surg Oncol 25(4):401–404. CrossRefPubMedGoogle Scholar
  4. 4.
    Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, Wei WI, Kong CK, Book KS, Yuen WC, Lam AK, Yuen NW, Trendell-Smith NJ, Chan YW, Wong BY, Li GK, Ho AC, Ho WK, Wong SY, Yao TJ (2009) Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck 31(6):765–772. CrossRefPubMedGoogle Scholar
  5. 5.
    Feng Z, Li JN, Li CZ, Guo CB (2014) 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 42(6):806–810. CrossRefPubMedGoogle Scholar
  6. 6.
    Nobis CP, Otto S, Grigorieva T, Alnaqbi M, Troeltzsch M, Schope J, Wagenpfeil S, Ehrenfeld M, Wolff KD, Kesting MR (2017) Elective neck dissection in unilateral carcinomas of the tongue: unilateral versus bilateral approach. J Craniomaxillofac Surg 45(4):579–584. CrossRefPubMedGoogle Scholar
  7. 7.
    Lydiatt DD, Robbins KT, Byers RM, Wolf PF (1993) Treatment of stage I and II oral tongue cancer. Head Neck 15(4):308–312CrossRefPubMedGoogle Scholar
  8. 8.
    Yuen AP, Wei WI, Wong YM, Tang KC (1997) Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck 19(7):583–588CrossRefPubMedGoogle Scholar
  9. 9.
    Haddadin KJ, Soutar DS, Oliver RJ, Webster MH, Robertson AG, MacDonald DG (1999) Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 21(6):517–525CrossRefPubMedGoogle Scholar
  10. 10.
    Keski-Santti H, Atula T, Tornwall J, Koivunen P, Makitie A (2006) Elective neck treatment versus observation in patients with T1/T2 N0 squamous cell carcinoma of oral tongue. Oral Oncol 42(1):96–101. CrossRefPubMedGoogle Scholar
  11. 11.
    Capote A, Escorial V, Munoz-Guerra MF, Rodriguez-Campo FJ, Gamallo C, Naval L (2007) Elective neck dissection in early-stage oral squamous cell carcinoma—does it influence recurrence and survival? Head Neck 29(1):3–11. CrossRefPubMedGoogle Scholar
  12. 12.
    Huang SF, Kang CJ, Lin CY, Fan KH, Yen TC, Wang HM, Chen IH, Liao CT, Cheng AJ, Chang JT (2008) Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer 112(5):1066–1075. CrossRefPubMedGoogle Scholar
  13. 13.
    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):14–19CrossRefPubMedGoogle Scholar
  14. 14.
    Corlette TH, Cole IE, Albsoul N, Ayyash M (2005) Neck dissection of level IIb: is it really necessary? Laryngoscope 115(9):1624–1626. CrossRefPubMedGoogle Scholar
  15. 15.
    Elsheikh MN, Mahfouz ME, Elsheikh E (2005) Level IIb lymph nodes metastasis in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: a molecular-based study. Laryngoscope 115(9):1636–1640. CrossRefPubMedGoogle Scholar
  16. 16.
    Lim YC, Song MH, Kim SC, Kim KM, Choi EC (2004) Preserving level IIb lymph nodes in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 130(9):1088–1091. CrossRefPubMedGoogle Scholar
  17. 17.
    De Zinis LO, Bolzoni A, Piazza C, Nicolai P (2006) Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection. Eur Arch Otorhinolaryngol 263(12):1131–1135. CrossRefPubMedGoogle Scholar
  18. 18.
    Koo BS, Lim YC, Lee JS, Choi EC (2006) Management of contralateral N0 neck in oral cavity squamous cell carcinoma. Head Neck 28(10):896–901. CrossRefPubMedGoogle Scholar
  19. 19.
    Abe M, Murakami G, Noguchi M, Yajima T, Kohama GI (2003) Afferent and efferent lymph-collecting vessels of the submandibular nodes with special reference to the lymphatic route passing through the mylohyoid muscle. Head Neck 25(1):59–66. CrossRefPubMedGoogle Scholar
  20. 20.
    Inoue H, Nibu K, Saito M, Otsuki N, Ishida H, Onitsuka T, Fujii T, Kawabata K, Saikawa M (2006) Quality of life after neck dissection. Arch Otolaryngol 132(6):662–666. CrossRefGoogle Scholar
  21. 21.
    Laverick S, Lowe D, Brown JS, Vaughan ED, Rogers SN (2004) The impact of neck dissection on health-related quality of life. Arch Otolaryngol Head Neck Surg 130(2):149–154. CrossRefPubMedGoogle Scholar
  22. 22.
    van den Brekel MW, Castelijns JA, Reitsma LC, Leemans CR, van der Waal I, Snow GB (1999) Outcome of observing the N0 neck using ultrasonographic-guided cytology for follow-up. Arch Otolaryngol Head Neck Surg 125(2):153–156CrossRefPubMedGoogle Scholar
  23. 23.
    Dunne AA, Folz BJ, Kuropkat C, Werner JA (2004) Extent of surgical intervention in case of N0 neck in head and neck cancer patients: an analysis of data collection of 39 hospitals. Eur Arch Otorhinolaryngol 261(6):295–303. CrossRefPubMedGoogle Scholar
  24. 24.
    Sano D, Myers JN (2007) Metastasis of squamous cell carcinoma of the oral tongue. Cancer Metastasis Rev 26(3–4):645–662. CrossRefPubMedGoogle Scholar
  25. 25.
    Werning JW, Heard D, Pagano C, Khuder S (2003) Elective management of the clinically negative neck by otolaryngologists in patients with oral tongue cancer. Arch Otolaryngol Head Neck Surg 129(1):83–88CrossRefPubMedGoogle Scholar
  26. 26.
    Jang JY, Kim MJ, Ryu G, Choi N, Ko YH, Jeong HS (2016) Prediction of lymph node metastasis by tumor dimension versus tumor biological properties in head and neck squamous cell carcinomas. Cancer Res Treat 48(1):54–62. CrossRefPubMedGoogle Scholar
  27. 27.
    Chen TC, Wang CP, Ko JY, Yang TL, Hsu CW, Yeh KA, Chang YL, Lou PJ (2013) The impact of perineural invasion and/or lymphovascular invasion on the survival of early-stage oral squamous cell carcinoma patients. Ann Surg Oncol 20(7):2388–2395. CrossRefPubMedGoogle Scholar
  28. 28.
    Lim YC, Choi EC (2007) Unilateral, clinically T2N0, squamous cell carcinoma of the tongue: surgical outcome analysis. Int J Oral Maxillofac Surg 36(7):610–614. CrossRefPubMedGoogle Scholar
  29. 29.
    Lim YC, Lee JS, Koo BS, Kim SH, Kim YH, Choi EC (2006) Treatment of contralateral N0 neck in early squamous cell carcinoma of the oral tongue: elective neck dissection versus observation. Laryngoscope 116(3):461–465. CrossRefPubMedGoogle Scholar
  30. 30.
    Chen MM, Harris JP, Hara W, Sirjani D, Divi V (2016) Association of postoperative radiotherapy with survival in patients with N1 oral cavity and oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg 142(12):1224–1230. CrossRefPubMedGoogle Scholar
  31. 31.
    Hao SP, Tsang NM (2002) The role of supraomohyoid neck dissection in patients of oral cavity carcinoma. Oral Oncol 38(3):309–312CrossRefPubMedGoogle Scholar
  32. 32.
    Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for R, Treatment of Cancer T (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. CrossRefPubMedGoogle Scholar
  33. 33.
    Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group I (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christoph Klingelhöffer
    • 1
  • Andreas Gründlinger
    • 1
  • Gerrit Spanier
    • 1
  • Stephan Schreml
    • 2
  • Maximilian Gottsauner
    • 1
  • Steffen Mueller
    • 1
  • Johannes K. Meier
    • 1
  • Torsten E. Reichert
    • 1
  • Tobias Ettl
    • 1
  1. 1.Department of Cranio- and Maxillofacial SurgeryHospital of the University of RegensburgRegensburgGermany
  2. 2.Department of DermatologyHospital of the University of RegensburgRegensburgGermany

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