T.T.Y.LIM1, J.Y.GAN1, E.W.FU1, M.Y.LIM1, H.LI1
Tan Tock Seng Hospital1
Selective neck dissection is the standard-of-care in the treatment of clinically node-negative (cN0) tongue squamous cell carcinoma (SCC). Whether the same can be done for clinical node-positive (cN+) tongue SCC is unclear. We aim to assess the pattern of nodal metastasis in tongue SCC and if it is oncologically safe to spare level 2b and 5 nodes to reduce the morbidity of spinal accessory nerve injury.
Retrospective review of all patients with tongue SCC who underwent resection and neck dissection between 2010-2016 in Tan Tock Seng Hospital.
Out of a total of 32 patients, 19 (59.4%) were cN0 and 13 (40.6%) were cN+ (majority of which underwent modified radical neck dissection). There was no pathological nodal involvement seen in level 2b or 5 but separation of level 2 into 2a and 2b was infrequent (30% of the neck dissections). Six (18.8%) and 15 (46.9%) patients had chemoradiotherapy and radiotherapy post-operatively, respectively. Six (18.8%) patients had neck recurrence during a median follow-up of 49.1 (range 0.0-125.1) months, and 66.7% of these were nodal recurrences with half in levels 1/2/3 and half in level 5. The median neck-recurrence-free interval was 10.0 (range 6.0-116.1) months. All neck recurrences accompanied local recurrence.
While pathological nodal metastasis in level 2b/5 was not seen, neck recurrences in those levels occurred, though accompanied by local recurrence in all cases. More data, especially on level 2b involvement, need to be collected before its sparing can be established as oncologically safe.