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From wide excision to a compartmental approach in tongue tumors: what is going on?

Calabrese, Lucaa; Tagliabue, Martaa; Maffini, Faustob; Massaro, Maria Angelaa; Santoro, Luigic

Current Opinion in Otolaryngology & Head and Neck Surgery: April 2013 - Volume 21 - Issue 2 - p 112–117
doi: 10.1097/MOO.0b013e32835e28d2
HEAD AND NECK ONCOLOGY: Edited by Piero Nicolai and Cesare Piazza

Purpose of review Surgical approaches to tongue cancer have not changed substantially over the years. The literature proposes some indications for tumor excision even though type of intervention, resection margins, neck dissection, and ‘en bloc’ resection versus separate excision of tumor and lymph nodes do not seem to be standardized. The purpose of this review is to describe the evolution of surgical management of tongue carcinoma with particular attention to recent reports focusing on compartmental tongue surgery.

Recent findings The current literature usually describes resection of tongue carcinoma within wide disease-free margins, ranging from 1.5 to 2 cm. In case of advanced-stage tumors, performing concomitant neck dissection is recommended; otherwise, a deferred neck dissection is indicated if depth of neoplastic infiltration exceeds 4 mm. In recent years, a new technical approach has been formulated based on anatomy of the tongue, thus, introducing the concept of an anatomy-based, function sparing, compartmental surgery.

Summary Applying such a proposal to clinical practice aims at standardizing a surgical procedure that otherwise might be arbitrary. Compartmental surgery improves overall survival, does not seem to worsen functional outcomes of the residual tongue, and allows comparison of case studies.

aDivision of Head and Neck Surgery

bDivision of Pathology and Laboratory Medicine

cDivision of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

Correspondence to Luca Calabrese, MD, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy. Tel: +39 02 574 894 90; fax: +39 02 943 792 16; e-mail: luca.calabrese@ieo.it

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins