FLOOR OF MOUTH CARCINOMA - THE MANAGEMENT OF THE CLINICALLY NEGATIVE NECK

Objectives: Examine the management of the clinically negative neck and evaluate the role of elective neck dissection in patients with squamo us carcinoma of the floor of the mouth. Design: Retrospective analysis of a cohort of patients with squamous carcinoma of the floor of the m outh and NO stage disease of the neck who were treated between 1973 an d 1992. The mean follow-up was 6 years. Patients: The cohort consisted of 129 patients. Excluded from analysis were patients without evidenc e of disease but less than 3 years of follow-up and those with uncerta in resection margins. Intervention: Resection of the floor of the mout h lesion with or without marginal mandibulectomy. Elective lymph-adene ctomy was performed in 26 (23%) of the 129 patients. Outcome Measure: Estimates were obtained of survival according to mode of therapy, clas sification of treatment modality, determinate cure, locoregional failu re, salvage, and occult disease by clinical stage. Results: Occult dis ease was detected in 23% of the patients who underwent elective neck d issection. Recurrence in the neck occurred in 36% of 103 patients who received follow-up but did not undergo elective neck dissection. The d eterminate survival at 3 years was 100% for patients with occult disea se who underwent elective neck dissection. Overall, 96% of the patient s who were treated with elective neck dissection were cured; 85% of th e patients who received no initial treatment of the neck were cured; a nd 59% of the patients with failure in the neck were salvaged. Conclus ions: A more aggressive approach to the neck with NO disease may be wa rranted. Selective neck dissection allows early removal of occult meta stases with acceptable morbidity. In elective dissection for clinicall y and histologically negative necks, the high rate of survival may res ult from the removal of metastatic carcinoma that was missed in the hi stopathologic sampling process.