En Block Versus Separate Management of Cervical Nodes in Tongue and Floor of the Mouth Cancers- Is There a Difference? An Analysis of 85 Cases in a Tertiary Care Institute

J F Neville; Mandar Tilak; Akhilesh Kumar Singh; Naresh Kumar Sharma; Janani Anand Kumar; Nitesh Mishra; Farhan Durrani

doi:10.1007/s12070-021-02743-1

En Block Versus Separate Management of Cervical Nodes in Tongue and Floor of the Mouth Cancers- Is There a Difference? An Analysis of 85 Cases in a Tertiary Care Institute

Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):6122-6128. doi: 10.1007/s12070-021-02743-1. Epub 2021 Jul 28.

Authors

J F Neville¹, Mandar Tilak¹, Akhilesh Kumar Singh², Naresh Kumar Sharma², Janani Anand Kumar², Nitesh Mishra², Farhan Durrani²

Affiliations

¹ Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India.
² Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India.

Abstract

To evaluate difference in local recurrence, regional (neck) recurrence as well as distant metastases between cases operated with en-block excision of primary cancer and neck nodes versus their separate removal, in squamous cell carcinomas of anterior 2/3 of tongue and floor of the mouth. A total 85 patients of cT1-T4a N0-N2b of carcinoma anterior 2/3 of tongue and floor of mouth were evaluated. Amongst these patients 39 cases of in-continuity en-block neck dissection and 46 cases of discontinuous neck dissection were evaluated for post-operative complications as well as oncological outcome for a follow up period of 3 years. Patient population was similar in both groups with tongue cancers being the commonest site and tobacco being the most common addiction. Primary site hematoma was seen more in the in-continuity en-block neck dissection group with a p-value of 0.0276, which was statistically significant. Post-operative oro-cutaneous fistula occurred more in in-continuity enblock neck dissection as compared to discontinuous neck dissection, but the difference was not statistically significant. Local recurrence rate was significantly more in cases of discontinuous neck dissection (19.565) as compared to in-continuity en-block neck dissection (5.12%) with a p-Value 0.0481. A statistically non-significant but higher loco-regional recurrence was observed in cases of discontinuous neck dissection as compared to cases of in-continuity en-block neck dissection (10.56% vs 2.56). In the present study recurrence-free survival RFS 3 year in cases of en-block in-continuity neck dissection (84.06%) cases as compared to discontinuous neck dissection cases (63.04%) with p Value 0.025698. In-continuity en-block in continuity neck dissection has lower loco-regional recurrence and may impact overall distant metastases. Though early postoperative complications are more in in-continuity en-block in continuity neck dissection as compared to discontinuous neck dissection, most are managed conservatively. Further studies with a larger sample size are needed to evaluate its outcome in a comprehensive manner.

Keywords: Discontinuous; Floor of the mouth; In-continuity; Neck dissection; Oral tongue; Squamous cell carcinoma.