Christopher-Philipp Nobis1, Sven Otto2, Tamara Grigorieva3, Mohamed Alnaqbi4, Matthias Troeltzsch5, Jakob Schöpe6, Stefan Wagenpfeil7, Michael Ehrenfeld8, Klaus-Dietrich Wolff9, Marco Rainer Kesting10. 1. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: christopher-nobis@t-online.de. 2. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: sven.otto@med.uni-muenchen.de. 3. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: tamara.grigorieva@web.de. 4. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: mohamed.alnaqbi@med.uni-muenchen.de. 5. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: matthias.troeltzsch@med.uni-muenchen.de. 6. Institute for Medical Biometry, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg/Saar, Germany. Electronic address: schoepe@med-imbei.uni-saarland.de. 7. Institute for Medical Biometry, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg/Saar, Germany. Electronic address: sw@med-imbei.uni-saarland.de. 8. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: michael.ehrenfeld@med.uni-muenchen.de. 9. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: wolff@mkg.med.tum.de. 10. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: marco.kesting@tum.de.
Abstract
PURPOSE: Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent. MATERIALS AND METHODS: A retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05). RESULTS: A total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures. CONCLUSION: As both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and esthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.
PURPOSE: Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent. MATERIALS AND METHODS: A retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05). RESULTS: A total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures. CONCLUSION: As both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and esthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.
Authors: Christoph Klingelhöffer; Andreas Gründlinger; Gerrit Spanier; Stephan Schreml; Maximilian Gottsauner; Steffen Mueller; Johannes K Meier; Torsten E Reichert; Tobias Ettl Journal: Oral Maxillofac Surg Date: 2018-03-29
Authors: Rutger Mahieu; Inne J den Toom; Koos Boeve; Daphne Lobeek; Elisabeth Bloemena; Maarten L Donswijk; Bart de Keizer; W Martin C Klop; C René Leemans; Stefan M Willems; Robert P Takes; Max J H Witjes; Remco de Bree Journal: Front Oncol Date: 2021-04-23 Impact factor: 6.244