Abstract: PURPOSE: To review the surgical data and related prognostic data of patients with advanced tongue cancer requiring total glossectomy, and to provide a reference for surgical decision-making and optimization in such patients. METHODS: Clinical data of 62 patients with advanced tongue cancer who underwent total glossectomy in Affiliated Hospital of Medical School, Nanjing University from January 2013 to December 2024 were collected. The patients were divided into two groups according to the surgical methods: group A(n=40) underwent lesion resection + neck dissection, and group B (n=22) underwent En bloc resection (En bloc removal of large cervical tissue and tongue cancer lesions). Kaplan-Meier method was used to analyze the survival rate, and Cox proportional hazards regression model was used to analyze the influencing factors of recurrence and metastasis. RESULTS: The recurrence and metastasis rate of group A was 17.50%(7/40), with a 3-year survival rate of 75.00%; the recurrence and metastasis rate of group B was 22.73% (5/22), with a 3-year survival rate of 68.18%. Cox regression analysis showed that there was no significant correlation between surgical method selection and postoperative recurrence and metastasis (P=0.537). There was no significant difference in the survival curves between the two groups (P=0.505). Subgroup analysis showed that there was no significant difference in survival rate between the two groups regardless of lymph node status(pN0-pN1, P=0.879; pN2-pN3, P=0.523). Lymph node status (pN2-pN3 vs pN0-pN1, HR=4.193, P=0.02) and extranodal extension(ENE positive, HR=4.158, P=0.016) were independent risk factors for postoperative recurrence and metastasis. CONCLUSIONS: The survival rate of patients with advanced tongue cancer is relatively low, and surgical plans should be comprehensively considered based on cervical lymph node status and tumor invasion. For patients with no preoperative clinical examination or imaging evidence of cervical lymph node metastasis or tumor protrusion into the submandibular space, "lesion resection + neck dissection" can be considered. If lymph node metastasis has occurred or the tumor has protruded into the submandibular space, En bloc resection should be performed, and attention should be paid to the management of the floor of mouth during operation. For soft tissue defects formed during operation, an appropriate repair method should be selected based on comprehensive consideration of multiple factors.

Key words: Advanced tongue cancer, En bloc resection, Neck dissection, Total glossectomy, Flap repair