NECK DISSECTION IN TREATMENT OF CARCINOMA OF ANTERIOR 2/3 OF TONGUE

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  • 1 January 1976
    • journal article
    • research article
    • Vol. 143  (1) , 75-80
Abstract
The records of 340 patients treated surgically over the 20 yr period 1950 through 1969 at this clinic for primary epidermoid carcinoma of the anterior 2/3 of the tongue were reviewed to evaluate the effectiveness of elective vs. therapeutic radical neck dissection in their treatment. There was a change in the clinical presentation of this disease, with more people presenting at an earlier stage, with a smaller primary lesion and fewer cervical node metastases. The over-all survival rate has shown a marked improvement to 69% at 5 yr. The proportion of women afflicted has increased. The status of the cervical nodes is a major prognostic factor, the determinant 5 yr survival rate being reduced from 78 to 26% if the nodes are metastatically involved. It cannot be directly proved that removal of occult metastasis to the neck by elective radical neck dissection before nodes are clinically detectable leads to a better survival rate partly because the 2 groups being compared are selected and not randomly assigned. However, the marked tendency for carcinoma of the tongue to metastasize regionally at some time in its course, the significant error in clinical evaluation of the neck, the significant conversion of clinically negative nodes to positive in patients not treated with radical neck dissection, the poor prognosis after treatment of conversion from clinically negative into positive, and the fact that more than half of the deaths are due to uncontrolled disease of the neck alone, favor the principle of elective radical neck dissection to enhance the survival time in the group of patients without clinical evidence of nodal involvement. With current surgical expertise, the mortality and morbidity rates of simultaneous radical neck dissection are low, and the potential benefit of the procedure outweighs its potential risks. Elective radical neck dissection, if beneficial, would most likely be so in patients with the highest likelihood of having occult metastasis. For this reason, emphasis was given to the correlation of site, size and histologic grade of the primary lesion with the presence of histologically verified regional metastasis. Used as a basis for selected elective radical neck dissection as against routine elective radical neck dissection, the risks can be made minimal while optimal benefit is obtained. It is recommended that all patients with T2 and T3 lesions have simultaneous elective neck dissection and that those with T1 lesions beyond grade 2 or spreading onto the floor of the mouth should be seriously considered for elective radical neck dissection.

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