INCIDENCE OF LYMPH-NODE METASTASIS IN ELECTIVE (PROPHYLACTIC) NECK DISSECTION FOR ORAL-CARCINOMA

Between 1970 and 1978, 280 patients with oral carcinoma situated in the tongue, floor of the mouth, mandibular gingiva and buccal mucosa, have been operated upon in the clinic of Oral and Maxillofacial Surgery of the University of Thessaloniki. Ninety-six (34.3%) patients presented with cervical lymph nodes, clinically palpable, of these two had contralateral and five bilateral glands, and in 184 (65.7%) the neck was clinically negative. Fifty-eight patients of those with a clinically negative neck, who had been operated conservatively by radical local excision and submandibular dissection, were excluded from this study. The remaining 222 patients regardless of the presence of lymph node metastasis have been operated upon with a composite procedure by the Commando (or a modified splitting technique) or Kremen type of operation, and a few of them by the pull-through technique with associated radical neck dissection. In the group of the 126 patients with negative neck nodes, the composite operation took place as an elective neck dissection. After serial examinations of the neck specimen of these patients, there were 48 instances (38.1%) of microscopically demonstrable metastases. The overall three-year survival (figure not corrected for age, sex, staging and type of operation) was 49.7%. Survival in the group operated by elective neck dissection was found to be 59.8% while in the group operated by the therapeutic neck dissection (patients with clinically positive neck) was found to be 35.3%. © 1979 Georg Thieme Publishers.