Clinical Articles
Recurrent neck disease in oral cancer*

https://doi.org/10.1053/joms.2002.33240Get rights and content

Abstract

Purpose: The goals were to examine the clinical and pathologic features of patients who developed metastatic squamous cell carcinoma in the cervical lymph nodes after initial treatment and to identify any common patterns. Patients and Methods: A retrospective analysis of 35 patients of varying initial tumor stage was performed. There were 18 patients who had an initial neck dissection and 17 patients whose neck was managed by a “watch and wait” policy. Results: Recurrence frequently involved level II nodes, and extracapsular spread was invariably present. The time taken for recurrence to develop was the same in both groups of patients (15 months, P =.35), and the overall median survival time after recurrence was 18 months (12 to 25 months, 95% confidence interval). In 27 of 29 patients (93%) who had the primary tumor resected, the thickness of tumor was greater than 5 mm. Conclusion: Neck recurrence may represent residual disease; it has histologically unfavorable features and consequently a poor prognosis. The frequency of recurrence at level II emphasizes the need for meticulous dissection in this region, and tumor thickness needs to be considered in planning treatment of the clinically negative neck. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:748-753, 2002

Section snippets

Patients and methods

All patients in whom recurrent neck disease had developed after attempted initial curative treatment were identified from the cancer databases of 3 maxillofacial centers: Blackburn Royal Infirmary, North Manchester General Hospital, and Manchester Royal Infirmary. The databases contained the records of 450 patients, from which 35 patients could be identified with recurrent neck disease. The pathology was reviewed and data were recorded. Statistical analysis was performed with the SPSS

Results

Twenty-two men and 13 women were studied. The mean age at presentation was 61.5 years. All except 2 patients were smokers, and 13 patients had an alcohol consumption in excess of the recognized safe limit of 28 units per week. Tumors of the tongue were most common, the posterior tongue disproportionately so (Fig 2).

. Site of primary tumor. FOM, floor of mouth.

The majority of tumors were either moderately or poorly differentiated.

Twenty-nine patients had surgical excision of the primary tumor; the

Discussion

This study confirms that patients with recurrent neck disease often get metastases at multiple levels and invariably have extracapsular spread. The time taken to develop recurrence is the same regardless of whether a neck dissection was performed. This suggests that in some circumstances, recurrence represents disease not successfully removed by elective neck dissection. The median time to develop metastasis was 15 months; this is the interval it takes for the metastasis to become palpable.

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    *

    Address correspondence and reprint requests to Dr Godden: Pigeon Box Farm, Rodley, Westbury-on-Severn, Gloucestershire, GL14 1QZ England; e-mail: [email protected]

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    Copyright © 2002 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.