OP168: Compartmental tongue surgery: A 10 years story

Abstract

Analyzing the cancer invasion pattern into the tongue we observed that the front of invasion follow the muscle fibers, horizontally into the intrinsic muscles and changing to a vertical direction when the extrinsic muscles are reached. The median tongue septum separating the genioglossus was almost never breached; when controlateral invasion occurred, it was via invasion of the intrinsic muscles above genioglossus. Other observed paths of tumour spread were: the fibrous and fatty tissue between genioglossus and hyoglossus muscles, the soft tissue between the hyoglossus muscle, the connective tissue of the floor of the mouth and the sublingual adipose tissue. We identify an anatomical (and functional) area into the tongue that can be at risk of being involved by cancer. We called this area tongue compartment and developed a rational surgical approach to tongue cancer resection: the compartmental surgery (CTS). This technique provides the complete removal of the involved muscle and sublingual tissues as to remove the path of disease spread and sites of potential residual foci. We perform CTS on 198 patients with primary untreated advanced tongue cancer from August 1999 to December 2009. After surgery, patients were followed in an outpatients up to 10 years. Their data of survival and functional recover were collected in a database and then statistically analyzed. 20 patients (10%) had local recurrences after 10 months (2–75 months). 18 patients (9%), had lymph node recurrences after 7 months (2–16 months); 24 patients (12%) had distant metastases after 13 months (1–87 months). Overall 5-yrs OS was 70.6% and 5-yrs DFS was 65.7%. The markedly improved outcomes in CTS patients, compared to those treated by standard surgery, suggest that CTS could be an anatomic approach to the surgical management of tongue cancer and provides better oncologic outcomes.