title: Elective neck dissection in unilateral carcinomas of the tongue: Unilateral versus bilateral approach.
abstract: OBJECTIVE
  Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent.
  
  
  METHODS
  A retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05).
  
  
  RESULTS
  A total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures.
  
  
  CONCLUSIONS
  As both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and esthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: christopher-nobis@t-online.de.
authors.forename: Christopher-Philipp
authors.initials: CP
authors.lastname: Nobis
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: sven.otto@med.uni-muenchen.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: tamara.grigorieva@web.de.
authors.forename: Tamara
authors.initials: T
authors.lastname: Grigorieva
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: mohamed.alnaqbi@med.uni-muenchen.de.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alnaqbi
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: matthias.troeltzsch@med.uni-muenchen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Troeltzsch
authors.affiliation: Institute for Medical Biometry, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg/Saar, Germany. Electronic address: schoepe@med-imbei.uni-saarland.de.
authors.forename: Jakob
authors.initials: J
authors.lastname: Schöpe
authors.affiliation: Institute for Medical Biometry, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg/Saar, Germany. Electronic address: sw@med-imbei.uni-saarland.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurmstraße 2a, D-80337 Munich, Germany. Electronic address: michael.ehrenfeld@med.uni-muenchen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: wolff@mkg.med.tum.de.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: marco.kesting@tum.de.
authors.forename: Marco Rainer
authors.initials: MR
authors.lastname: Kesting
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Elective neck dissection; Head and neck cancer; Oral and maxillofacial surgery; Oral tongue squamous cell carcinoma; Surgical oncology