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Updated: Jun 2, 2026
Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
Prophylactic neck dissection in early oral tongue squamous cell carcinoma 2.1 to 4.0 mm depth
Matthew J Lin1, Anthony Guiney, Claire E Iseli
1Department of Otolaryngology, Head & Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Objective:
Regional recurrence is common following surgery for T1/T2 oral tongue squamous cell carcinoma (SCC). Tumor depth >4.0 mm is commonly assigned as an indication for prophylactic neck dissection to improve regional control. Prophylactic neck dissection may detect extracapsular extension, a poor prognostic sign where adjuvant chemotherapy is indicated. The hypothesis in this study is that regional recurrence is a significant problem in 2.1- to 4.0-mm-depth tumors, and detection of extracapsular extension may be important in this group.
Study Design:
Retrospective chart review.
Setting:
Australian tertiary referral center.
Subjects And Methods:
Review of all patients with T1/T2 oral tongue SCC treated surgically between January 1991 and January 2009 (n = 81).
Results:
Twenty-nine prophylactic and 5 therapeutic neck dissections followed for a median 34 months (range, 4-132 months). Tumor depths were 0 to 2.0 mm (n = 15), 2.1 to 4.0 mm (n = 18), 4.1 to 7.0 mm (n = 26), and >7.0 mm (n = 22). Tumors 2.1 to 4.0 mm depth had similar rates of occult nodes as 4.1 to 7.0 mm depth (25% vs 20%). Regional recurrence occurred in 31% overall, 44% in tumors 2.1 to 4.0 mm, and 27% in tumors 4.1 to 7.0 mm depth. Prophylactic neck dissection reduced regional recurrence (17% vs 43%, P = .02). Patients with pathologically negative necks had lower rates of regional recurrence than those with occult nodes (9% vs 50%, P < .01). Extracapsular extension increased regional recurrence (43% vs 7%, P = .02), including 25% of dissected necks with tumor depth 2.1 to 4.0 mm.
Conclusions:
Regional recurrence is a significant problem in 2.1- to 4.0-mm-depth T1/T2 tongue tumors. Prophylactic neck dissection may improve regional control in patients with adequate primary resection margins and determine need for adjuvant therapies in 2.1- to 4.0-mm-depth tumors.
