Anatomisch-geführter kompartimental Ansatz bei fortgeschrittenen Zungentumoren

Zusammenfassung

Zielsetzung

Die traditionelle Chirurgie des Plattenepithelkarzinoms der Zunge basiert auf der Resektion mit definierten Sicherheitsabständen.

Das biologische Verhalten von Zungen- und Mundbodenkrebs kann jedoch unvorhersehbar sein und oft das zuvor erwähnte Konzept sicherer chirurgischer Ränder umgehen, aufgrund der Komplexität der Zungenanatomie und der Existenz multipler Tumorausbreitungswege, einschließlich extrinsischer Muskelfasern, neurovaskulärer Strukturen und lymphatischer Netzwerke, die es dem Neoplasma ermöglichen, über seine sichtbaren makroskopischen Grenzen hinauszugehen.

Methoden

Auf der Grundlage dieser multipler Ausbreitungswege wurde in den letzten zwei Jahrzehnten die kompartimentale Chirurgie zur Behandlung von Zungen- und Mundbodenkrebs als Alternative zu traditionelleren transoralen Resektionen vorgeschlagen. Dieses Verfahren basiert auf der En-bloc-Resektion des Tumors, der zervikalen Lymphknoten und des Tumor-Knoten-Traktes entlang anatomischer Ausbreitungswege. Eine Literaturübersicht wurde anhand relevanter Schlüsselbegriffe durchgeführt: (tongue carcinoma) OR (tongue cancer) OR (oral cavity cancer) AND (compartmental surgery).

Ergebnisse

Vierzehn Studien wurden analysiert. Die Ergebnisse beschreiben ein anatomiebasiertes, funktionsschonendes Operationskonzept. Im Vergleich zur konventionellen partiellen Glossektomie zeigte die kompartimentale Chirurgie verbesserte onkologische Ergebnisse bei vergleichbaren funktionellen Resultaten.

Schlussfolgerungen

Die kompartimentale Chirurgie stellt ein standardisiertes und reproduzierbares Verfahren zur Behandlung des Zungenkarzinoms dar, das ausreichende onkologische Radikalität mit funktionellem Erhalt verbindet.

Abstract

Objectives

Traditional surgery for squamous cell carcinoma of the tongue is based on tumor excision with predefined safety margins. However, due to the complex anatomy of the tongue and multiple tumor spread pathways, this approach may fail to achieve adequate oncological control.

Methods

Compartmental surgery has been proposed as an alternative approach, based on en-bloc resection of the tumor, cervical lymph nodes, and tumor-node tract, following anatomical pathways of spread. A literature review was conducted using the keywords: (tongue carcinoma) OR (tongue cancer) OR (oral cavity cancer) AND (compartmental surgery).

Results

Fourteen relevant studies were analyzed. The reviewed literature describes an anatomy-based, function-preserving surgical concept. Compared to conventional partial glossectomy, compartmental surgery demonstrated improved oncological outcomes without significant impairment of functional results.

Conclusions

Compartmental surgery represents a standardized and reproducible approach for tongue cancer, providing adequate radicality while preserving function through anatomy-based surgical principles.

Schlüsselwörter

Kompartimentale Chirurgie - Karzinom der Zunge - Zungenchirurgie - Tumor der Zunge - Mundhöhlenkarzinom

Keywords

Compartmental surgery - Carcinoma of the tongue - Tongue surgery - Tumor of the tongue - Oral cavity carcinoma

Publication History

Received: 06 November 2025

Accepted after revision: 09 January 2026

Article published online:
13 February 2026

• Literatur

• 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
• 2 Yuen AP, Lam KY, Wei WI. et al. A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma. Am J Surg 2000; 180: 139-143
• 3 Calabrese L, Giugliano G, Bruschini R. et al. Technical note compartmental surgery in tongue tumors: description of a new surgical technique. Acta Otorhinolaryngol Ital 2009; 29: 259-264
• 4 Calabrese L, Bruschini R, Giugliano G. et al. Compartmental tongue surgery: long-term oncologic results in the treatment of tongue cancer. Oral Oncol 2011; 47: 174-179
• 5 Piazza C, Grammatica A, Montalto N. et al. Compartmental surgery for oral tongue and floor of the mouth cancer: oncologic outcomes. Head Neck 2019; 41: 110-115
• 6 Calabrese L, Tagliabue M, Grammatica A. et al. Compartmental tongue surgery for intermediate-advanced squamous cell carcinoma: A multicentric study. Head Neck 2023; 45 (11) 2862-2873
• 7 Grammatica A, Piazza C, Ferrari M. et al. Step-by-Step Cadaver Dissection and Surgical Technique for Compartmental Tongue and Floor of Mouth Resection. Front Oncol 2021; 11: 613945
• 8 Fazio E, Gazzini L, Gazzini S. et al. Step by step pull-through compartmental hemiglossectomy. Am J Otolaryngol 2024; 45 (04) 104372
• 9 Sanders I, Mu L. A three-dimensional atlas of human tongue muscles. Anat. Rec 2013; 296: 1102-1114
• 10 Calabrese L, Bizzoca ME, Grigolato R. et al. From Bench to Bedside in Tongue Muscle Cancer Invasion and Back again: Gross Anatomy, Microanatomy, Surgical Treatments and Basic Research. Life (Basel) 2020; 10 (09) 197
• 11 Tagliabue M, Gandini S, Maffini F. et al. The role of the T-N tract in advanced stage tongue cancer. Head Neck 2019; 41 (08) 2756-2767
• 12 Gazzini L, Fazio E, Dallari V. et al. Beyond the boundaries of compartmental hemiglossectomy: a proposal for an anatomically based classification of surgical approaches to advanced oral tongue squamous cell carcinoma. Eur Arch Otorhinolaryngol 2023; 280 (06) 3015-3022
• 13 Bakst RL, Glastonbury CM, Parvathaneni U. et al. Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2019; 103 (05) 1109-1124
• 14 Larson AR, Kemmer J, Formeister E. et al. Beyond Depth of Invasion: Adverse Pathologic Tumor Features in Early Oral Tongue Squamous Cell Carcinoma. Laryngoscope 2020; 130 (07) 1715-1720
• 15 Deborde S, Omelchenko T, Lyubchik A. et al. Schwann cells induce cancer cell dispersion and invasion. J Clin Invest 2016; 126 (04) 1538-54
• 16 Vural E, Hutcheson J, Korourian S. et al. Correlation of neural cell adhesion molecules with perineural spread of squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2000; 122 (05) 717-20
• 17 Sittitrai P, Srivanitchapoom C, Mahanupab P. et al. Impact of clinical and histopathological prognostic factors on T1–2N0–1 oral tongue cancer. Indian J Otolaryngol Head Neck Surg 2013; 65 (01) 66-70
• 18 Zanoni DK, Montero PH, Migliacci JC. et al. Survival outcomes after treatment of cancer of the oral cavity (1985–2015). Oral Oncol 2019; 90: 115-121
• 19 Werner JA, Dünne AA, Myers JN. Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck 2003; 25: 322-32
• 20 Abe M, Murakami G, Noguchi M. et al. Afferent and efferent lymph-collecting vessels of the submandibular nodes with special reference to the lymphatic route passing through the mylohyoid muscle. Head Neck 2003; 25: 59-66
• 21 Rouviere H. Anatomy of the human lymphatic system. Michigan, Ann Arbor: Edwards Brother, Inc; 1938
• 22 Suzuki M, Eguchi K, Ida S. et al. Lateral lingual lymph node metastasis in tongue cancer and the clinical classification of lingual lymph nodes. J Jpn Soc Head Neck Surg 2016; 26: 71-78
• 23 Eguchi K, Suzuki M. Survival Impact of Lingual Lymph Node Metastases in Tongue Cancer: An Analysis Regarding Anatomical Subsites. In vivo 2023; 1328-1333
• 24 Gvetadze SR, Mudunov AM, Roshchina EA. et al. Surgical anatomy of the lingual lymph nodes: systematic literature analysis and proposition for topographic classification. Surg Radiol Anat 2023; 45 (03) 227-239
• 25 Kain JJ, Birkeland AC, Udayakumar N. et al. Surgical margins in oral cavity squamous cell carcinoma: Current practices and future directions. Laryngoscope 2020; 130 (01) 128-138
• 26 Gazzini L, Dallari V, Fazio E. How I do it: Transoral surgical approach to early-stage oral tongue squamous cell carcinoma (with video). Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 (Suppl. 2) 45-46
• 27 Calabrese L, Pietrobon G, Fazio E. et al. Anatomically-based transoral surgical approach to early-stage oral tongue squamous cell carcinoma. Head Neck 2020; 42 (05) 1105-1109
• 28 Ansarin M, Bruschini R, Navach V. et al. Classification of GLOSSECTOMIES: Proposal for tongue cancer resections. Head Neck 2019; 41: 821-827
• 29 Grammatica A, Piazza C, Montalto N. et al. Compartmental Surgery for Oral Tongue Cancer: Objective and Subjective Functional Evaluation. Laryngoscope 2021; 131 (01) E176-E183
• 30 Gazzini L, Caselli A, Dallari V. et al. Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy. Front Surg 2024; 11: 1395936
• 31 Gazzini L, Dallari V, Caselli A. et al. Modular anatomic approach to oral tongue carcinoma: functional outcomes and quality of life. Acta Otorhinolaryngol Ital 2024; 44: 285-295