Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth

A retrospective study was undertaken of patients with T1N0M0 squamous cell carcinoma of the oral tongue and floor of the mouth who underwent surgical treatment between 1985 and 1995. Evaluation of two groups of patients (neck dissection versus observation) was made according to the management of the neck. Results were obtained regarding the presence of occult metastases, r ecurrence in the neck, treatment failure, results of salvage treatment, and disease-free survival. Forty-nine patients underwent surgical treatment: 2 5 resection of primary and 24 resection plus neck dissection. Overall incid ence of regional metastases was 24.5%. Eight patients (16%) developed recur rence of the disease. Seven (14%) had regional recurrences (including 1 wit h distant metastases) and 1 (2%) had local recurrence. Twenty-four percent of patients from the resection of primary group developed neck recurrences in comparison with 4% of the resection plus neck dissection group (P = 0.05 ). Overall salvage rate was 37.5%. Second primary tumors developed in 16% o f patients. Patients who underwent elective neck dissection had a 23% highe r disease-free survival rate compared with those who underwent resection of the tumor alone (P = 0.03). The findings of this study stress the importan ce of control of the neck in early oral cancer. Elective neck dissection si gnificantly improved regional control of the disease.