Compartmental Tongue Surgery Revisited: Oncologic Outcomes in Over 100 cT4a Oral Tongue Cancer Patients from a Single Cancer Institute.

Compartmental tongue surgery involves the removal of all extrinsic tongue muscles, neurovascular tissue, and intermediate lymph nodes with the tumour. The five-year overall survival in cT3/T4a cancers was 70.7%. The disease-free survival of cT4a tongue cancers undergoing compartmental tongue surgery (CTS) at Mahavir Cancer was prospectively estimated. Disease-free survival (DFS) of 102 consecutive cT4a Oral Tongue cancer patients treated with CTS and adjuvant therapy, prospectively followed from 2017 to 2024, was estimated. Other variables included age, gender, use of NACT, type of glossectomy, pathological T and N status, tumour differentiation, Extranodal extension (ENE), Lymphovascular invasion (LVI), perineural involvement (PNI), depth of tumour invasion (DOI),and margin status. One-year DFS was 49.8% while two-year DFS was 40.7%. Most recurrences occurred within the first two years. Patients undergoing type IVB glossectomy and tumours with depth of invasion more than 1.4 cm had a significantly higher risk of adverse event. Elective dissection of the opposite neck significantly improved survival. Compartment tongue excision is feasible in locally advanced T4a cancers, resulting in 49.8% one-year and 40.7% 2-year disease-free survival. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-025-02201-2.