ELECTIVE NECK DISSECTION VERSUS OBSERVATION IN THE TREATMENT OF EARLYORAL TONGUE CARCINOMA

Background. The aim of the present review is to evaluate the results o f elective neck dissection and ''watchful waiting'' in the surgical tr eatment of stages I and II squamous cell carcinoma of oral tongue. Met hods. This is a retrospective study of patients with surgical treatmen t between January 1980 and December 1994. Results. There were 63 patie nts including those with 34 T1 and 29 T2 carcinoma. The first sites of tumor recurrence were 5 (8%) local, 17 (27%) regional, 2 (3%) distant , 1 (2%) locoregional, and 1 (2%) both regional and distant. Of the 30 NO neck patients who had no elective neck dissection, the regional re currence rate was 47%, and eventually 23% died of tumor related to reg ional recurrence, Elective neck dissection significantly reduced the r egional recurrence rate to 9% and also significantly reduced the regio nal recurrence related mortality to 3%. Elective neck dissection also increased the 5-year disease-free actuarial survival rate to 86% compa red with 55% for ''watchful waiting''. Conclusions. Regional recurrenc e was the most common cause of failure after surgical treatment of ora l tongue carcinoma. Elective neck dissection significantly reduced mor tality due to regional recurrence and also increased the overall survi val, There was no significant difference between elective radical neck dissection and selective I, II, and III neck dissection in the improv ement of treatment results, This retrospective study suggests that ele ctive selective I, II, III neck dissection is a treatment strategy of choice for stages I and II carcinoma of the oral tongue. A prospective randomized study is worthwhile to further evaluate the benefit of ele ctive neck dissection in the treatment of early carcinoma of the tongu e. (C) 1997 John Wiley & Sons, Inc.