Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma

BACKGROUND: Elective treatment of the neck in oral squamous cell carcinoma has changed over the last 20 years. The main object of this report is to pr esent the results of a multi-institutional prospective study designed to co mpare standard treatment with modified radical classical neck dissection (M RND) to supraomohyoid neck dissection (SOH) in the management of the clinic ally negative neck in oral cancer patients. PATIENTS AND METHODS: A total of 148 patients were included in the trial. A ll patients had previously untreated T2 to T4 NO squamous cell carcinoma of the oral tongue (62 cases), floor of the mouth (49 cases), inferior gingiv a (12 cases), or retromolar trigone (25 cases). Tumor stages were T2, 91; T 3, 27; and T4, 30. There were no significant imbalances between groups. RESULTS: The false-negative rate was 23%, and most positive nodes were site d at level II and III. Complications were seen in 41% of MRND patients and in 25% of SOH patients (P = 0.043). Median total duration of hospitalizatio n was 9 days in MRND patients and 7 days in the SOH group. To date, 19 and 16 patients presented with local and neck recurrences, respectively. The 60 -month actuarial survival rates were 63% in the MRND group and 67% in the S OH group (P = 0.7150). CONCLUSIONS: This study demonstrates that the recurrence and survival rates were similar in both groups. SOH neck dissection can be recommended as sta ndard elective treatment for patients with T2-T4 oral squamous cell carcino mas. Am J Surg. 1998;176:422-427. (C) 1998 by Excerpta Medica, Inc.