Sublingual gland resection in squamous cell carcinoma of the floor of mouth: is it necessary?

OBJECTIVES: Little evidence exists to guide surgeons in the management of the sublingual glands (SLG) not macroscopically involved by squamous cell carcinoma of the floor of mouth and oral tongue. This study aims to determine the frequency with which the SLG is invaded, to identify variables predicting for SLG invasion and the morbidity associated with it's resection in entirety. STUDY DESIGN: Retrospective cohort study. METHODS: A review of 164 patients treated for oral cavity cancer at a tertiary institution with a large volume of head and neck malignancy was performed. Demographic data, rates of surgical complications and follow up information was recorded. Pathologic review of resected material in this group yielded 134 specimens in the region of the SLG. A detailed analysis of 63 specimens in which the SLG was included was carried out. RESULTS: The median age was 58 years, mean follow up was 2.2 years, and there were 44 males and 19 females. Seventeen cases (27%) demonstrated histopathological SLG invasion. In patients with SLG involvement, this was evident at the time of surgery in 15 patients (88%). Microscopic SLG invasion, without macroscopic evidence at surgery, was present in only 4.2% of patients undergoing SLG resection. Clinical and pathological T stage (p = 0.023 and 0.005) and tumor thickness (p = 0.015) predicted for SLG invasion. Total SLG resection significantly increased the post-operative wound complication rate from 14% in patients without SLG resection to 25% (p = 0.05). CONCLUSION: Total SLG resection in early stage and thin squamous cell carcinoma of the floor of mouth and oral tongue provides minimal oncologic benefit and is associated with increased perioperative morbidity due to neck wound complications.

Established prognostic variables in N0 oral carcinoma.

OBJECTIVES: To examine the utility of established prognostic variables in patients with oral carcinoma and a clinically negative neck. STUDY DESIGN: Retrospective cohort study. METHODS: The distribution of occult metastases was assessed in 105 oral cancer patients with no clinical or radiological evidence of nodal disease. Predictors for nodal metastases, recurrence, and survival were examined. RESULTS: Occult neck metastases occurred in 34 percent of patients. Tumor thickness was the only independent predictor of occult metastases, with thin (5 mm) tumors having a 10 percent and 46 percent incidence of regional disease, respectively (P = 0.001). Nodal metastases and perineural invasion were significant predictors of survival. CONCLUSION: Patients with thick tumors are at high risk of nodal metastases and are likely to benefit from elective neck dissection. Comprehensive neck dissection should be considered in advanced primary disease. SIGNIFICANCE: Tumor thickness is the most important predictor of occult regional metastases in oral cavity cancer.