Role of Prophylactic Neck Dissection in Node Negative Carcinoma of Tongue

Prophylactic Neck Dissection in Carcinoma of Tongue

  • Kaushik Hari Assistant Professor, Department of Surgical Oncology, Saptagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  • CN Srikanth Assistant Professor, Department of Surgical Oncology, Saptagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
Keywords: Carcinoma tongue, cN0, cervical lymph node netastases, wide local excision, modified radical neck dissection, supraomohyoid neck dissection, post operative radiotherapy, advanced imaging techniques

Abstract

Background: To ascertain the role of prophylactic neck dissection in cN0 tongue cancers. To assess the role of tumour thickness as a guide  for the choice type of neck dissection in tongue cancers. Subjects and Methods: A single institutional study by the Department of Surgical Oncology in a teritiary care centre. Biopsy of the tumour site has been done and biopsy proven carcinoma tongue cases have been included in the study. A total of 110 cases of carcinoma tongue were recorded. 50 cases out of the 110 cases were cN0. All the cases were operated by wide local excision of primary tumour and modified radical neck dissection. After the histopathological assessment tumours were divided into two categories, tumours with thickness more than 4mm and those with thickness less than 4mm. Pathological node positivity in both these categories is studied. All the cases were followed up and those with positive nodes were advised post-operative radiotherapy. Results: Among 110 cases studied 50 cases have no clinical nodes at presentation and 60 had cervical lymph node metastases at presentation. Among the 50 cases with no clinical nodes at presentation, histopathology showed that 20 cases (40%) had primary tumour less than 4mm and 30 cases(60%) had primary tumour more than 4mm. 10 of the 20 cases(50%) with tumour thickness less than 4mm had lymph node metastases on pathological assessment and 24 of the 30 cases(80%) with tumour thickness more than 4mm had lymph node metastases on pathological assessment. Among the the category of tumor thickness less than 4mm, 4 cases (20%) had lymph node metastases to level 1, 3 cases (15%) had lymph node metastases to level 2, 3 cases (15%) had lymph node metastases to level 3, 1 case (5%) had lymph node metastases to level 4. Among category of tumour thickness more than 4mm, 10 cases (33.3%) had metastases to level 1, 9 cases (30%) had metastases to level 2, 5 cases(16.6%) had metastases to level 3, 3 cases(10%) had metastases to level 4 and 4 cases (13.33%) had metastases to level 5. Conclusion: The role of neck dissection is the most important step in the management of carcinoma tongue. Prophylactic neck dissection has a definitive role in clinically node negative tongue cancers. Type of neck dissection based on our results showed supraomohyoImid neck dissection would be sufficient for tumours less than 4mm and modified radical neck dissection for tumours more than 4mm thickness. Even most advanced imaging techniques like PET scan and SLNB could not completely derail the need for prophylactic neck dissection in carcinoma tongue.

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References

Parkin DM, Whelan SL, Ferlay J. Cancer incidence . 1997;11(3):24–9.

Indian Council of Medical Research: Annual reports of National Cancer Registry project of India. ICMR. 1982;17(4):113–8.

Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NHA, et al. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue? Head Neck. 1998;20(2):138–144. Available from: https://dx.doi.org/10.1002/(sici)1097-0347(199803).

Warnakulasuriya S. Global epidemiology of oral and oropha- ryngeal cancer. Oral Oncology. 2009;45(4-5):309–316. Avail- able from: https://dx.doi.org/10.1016/j.oraloncology.2008.06.002.

Ren ZH, Wu HJ, Tan HY, Wang K, Zhang S. Transfer of anterolateral thigh flaps in elderly oral cancer patients: complications in oral and maxillofacial reconstruction. J Oral Maxillofac Surg. 2015;73:534–574. Available from: https://doi.org/10.1016/j.joms.2014.09.021.

Bocca E, Pignatarao O, Oidini C. Functional neck dissection: an evaluation of 853 cases. Laryngoscope. 1984;94:942– 947. Available from: https://doi.org/10.1288/00005537-198407000-00015.

Byers RM. Modified neck dissection: a study of 967 cases from 1970 to 1980. Am J Surg. 1985;150:414–435. Available from: https://doi.org/10.1016/0002-9610(85)90146-1.

Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990;160:405–414.

Tytor M, Olofsson J. Prognostic Factors in Oral Cavity Carci- nomas. Acta Otolaryngol Suppl . 1992;492:75–78. Available from: https://dx.doi.org/10.3109/00016489209136815.

Merritt RM, Williams MF, James TH, Porubsky ES. Detection of Cervical Metastasis: A Meta-analysis Comparing Computed Tomography With Physical Examination. Arch Otolaryngol Head Neck Surg . 1997;123(2):149–152. Available from: https://dx.doi.org/10.1001/archotol.1997.01900020027004.

Stuckensen T, Kovács AF, Adams S, Baum RP. Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg. 2000;28(6):319–324. Available from: https://dx.doi.org/10.1054/jcms.2000.0172.

Fakih AR, Rao RS, Borges AM, Patel AR. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg. 1989;158(4):309–313. Available from: https://dx.doi.org/10.1016/0002-9610(89)90122-0.

Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994;168(5):391–394. Available from: https://dx.doi.org/10.1016/s0002-9610(05)80082-0.

Mohit-Tabatabai MA, Sobel HJ, Rush BF, Mashberg A. Rela- tion of thickness of floor of mouth stage I and II cancers to regional metastasis. Am J Surg. 1986;152(4):351–353. Avail- able from: https://dx.doi.org/10.1016/0002-9610(86)90303-x.

Urist MM, O’Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: Analysis of prognostic factors. Am J Surg. 1987;154(4):411–414. Avail- able from: https://dx.doi.org/10.1016/0002-9610(89)90014-7.

Published
2020-12-31