Role of elective neck dissection in the management of early oral tongue carcinoma

Abstract

Objective: To evaluate the efficacy of elective neck dissection as a therapeutic as well as diagnostic procedure for early oral tongue cancer patients with N0 neck. Methods: This observational, retrospective study was carried out during the period of July 2012 to December 2014, among the patients admitted in the department of ENT Oncology of National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka. For this study, patients of early oral tongue cancer (T1 & T2) of all age & sex, which were with clinically N0 neck, were included. Detailed history taking, thorough clinical examination of oral cavity, neck and preoperative punch biopsy from the tongue lesion was done in every case. Wide local excision or hemiglossectomy with proper margin clearance in all cases and elective neck dissection was done in selective cases. Histopathological examination of excised primary tongue lesion & neck nodes were also done in all cases. Results: There were 30 patients in this study, including 14(46.66%) with T1 and 16(53.33%) with T2 oral tongue carcinoma. The first site of tumour recurrence was regional that is 6 (20%), both regional & local were 1(3.33%) and local recurrence was 2(6.66%). Among the 30 N0 neck patients, who had done neck dissection (18 patients), regional recurrence was seen in 2 cases (11.11%) and patients who were under observation (12 patients), recurrence was seen in 5 cases that is 41.66%. The recurrence is significantly high in patients who were in observation. At the same time occult node positive disease was found interestingly in 33.33% cases. So elective neck dissection has the advantage of more accurate pathological diagnosis or staging of neck. Conclusion: Elective neck dissection significantly reduces the regional recurrence in case of management of early oral tongue cancer. At the same time it is also a very important diagnostic tool.