What is optimum neck dissection for T3/4 buccal-gingival cancers?

Buccal-gingival (BG) cancers are an integral part of oral cancers but are biologically distinct, particularly with regard to the propensity and pattern of neck metastases. This study was undertaken to examine the adequacy of limited neck dissection in the management of these tumors. Between 1980 and 1989, 527 T3/4 BG cancers were treated surgically at Tata Memorial Hospital, Bombay. These cases were reviewed retrospectively. Among these, 178 underwent radical neck dissection (RND), 166 supradigastric dissection (SD) and 183 supraomohyoid dissection (SOHD) after confirming the negativity of levels II and III for nodal disease on frozen section. The overall incidence of histological node positivity was 42.5% (224/527). Level I was the most frequent site of metastases, with a skip rate of only 9%. The incidence of pure regional failure (primary controlled) was 3% with RND (67/178), 12% with SD (11/95) and 5% with SOHD (7/141) in patients with N0 necks. In the N+ category the regional failure was 18% with RND (20/111), 34% with SD (24/71) and 19% with SOHD (8/42). These findings show that a limited (SD) dissection is grossly inadequate in the management of T3/4 BG cancers, whereas an SOHD when neck levels II and III are confirmed negative on frozen section yields results comparable to RND for both N0 and N+ necks.