British Journal of Oral and Maxillofacial Surgery 52 (2014) 590–597 Available online at www.sciencedirect.com Does elective neck dissection in T1/T2 carcinoma of the oral tongue and floor of the mouth influence recurrence and survival rates? Natalie Kelner a , José Guilherme Vartanian a , Clóvis Antônio Lopes Pinto b , Cláudia Malheiros Coutinho-Camillo b , Luiz Paulo Kowalski a,* a Department of Head and Neck and Otorhinolaryngology Surgery, ACCamargo Cancer Center, São Paulo, Brazil b Department of Pathology, ACCamargo Cancer Center, São Paulo, Brazil Accepted 27 March 2014 Available online 17 May 2014 Abstract The aim of this study was to evaluate the results of elective neck dissection compared with observation (control group) in selected cases of early carcinoma of the oral tongue and floor of the mouth. It was a retrospective analysis of 222 patients who had the tumour resected (161 also had elective neck dissection). Occult lymph node metastases were detected in 33/161 (21%), and neck recurrences were diagnosed in 10 of the 61 patients in the control group (16%). Occult lymph node metastases reduced the 5-year disease-specific survival from 90% to 65% (p = 0.001) and it was 96% among the controls. The 5-year disease-specific survival was 85% in the group treated by neck dissection and 96% in the observation group (p = 0.09). Rigorous follow-up of selected low risk patients is associated with high rates of salvage, and overall survival was similar to the observed survival in patients treated by elective neck dissection. Observation is a reasonable option in the treatment of selected patients. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Oral cancer; Squamous cell carcinoma; Early stage; Lymph nodes; Elective neck dissection Introduction Oral squamous cell carcinoma (SCC) is characterised by a high risk of metastases to lymph nodes in the neck. 1 The metastatic spread of these tumours usually occurs through the lymphatic system in the neck, at levels I–III. 2,3 * Corresponding author at: Department of Head and Neck Surgery and Otorhinolaryngology, ACCamargo Cancer Center, Rua Professor Antônio Prudente, 211, São Paulo, SP CEP: 01509-900, Brazil. Tel.: +55 1121895172. E-mail addresses: nataliekelner@yahoo.com.br (N. Kelner), jgvartanian@uol.com.br (J.G. Vartanian), coipinto@uol.com.br (C.A.L. Pinto), claumcc@terra.com.br (C.M. Coutinho-Camillo), lp kowalski@uol.com.br (L.P. Kowalski). The incidence of occult lymph node metastases in early oral SCC ranges from 14% to 45%, and is higher in tumours of the tongue and floor of the mouth. 4–7 The presence of pathological lymph node metastases is the most important prognostic factor, and it reduces survival in patients with oral SCC. 4,8–13 Computed tomography (CT), magnetic res- onance imaging (MRI), ultrasonography (US), and positron emission tomography-CT (PET-CT) are used to detect neck metastases, but none can detect all micrometastases. 5,11,14,15 The high incidence of occult metastases is the most impor- tant argument in favour of elective neck dissection in oral cancer. However, the functional and cosmetic side effects, morbidity, and costs argue against it. 15,16 It is recommended only in patients with an estimated risk of metastases of more than 20%. 8 http://dx.doi.org/10.1016/j.bjoms.2014.03.020 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.