Reconstructive procedures in maxillofacial oncosurgery.

Richard Pink,Bohumil Zalesak,Jindrich Pazdera,Vitezslav Zboril,Martin Molitor,Petr Michl,Peter Tvrdy

doi:10.5507/bp.2014.055

Abstract

Oropharyngeal cancers are a biologically heterogenous group of tumors with diverse risk factors including tobacco, alcohol, HPV, inherited disorders, the acquired immunodeficiency of Karposi's Sarcoma and non Hodgkin's lymphoma. In the Czech Republic, oropharyngeal cancers represent around 2% of all cancers. The treatment of these tumors is long and complex. Reconstructive procedures in maxillofacial oncosurgery demand good interdisciplinary collaboration and great professional preparedness of the surgical and nursing team. Patient age and stage of disease, including the presence of metastases are of key importance. A prerequisite for the success of surgical treatment is removal of the tumor with a sufficient safety margin. Reconstructive procedures then follow. To highlight the importance of radical tumor resection and describe reconstruction of the defect in a group of our patients. From 2008 to 2013, 23 patients with oropharyngeal carcinoma underwent radical surgical removal of tumor, followed by reconstruction of postoperative defects using distant and free flaps. The histopathology showed predominantly squamous cell carcinomas and one of Merkel cell carcinoma. 16 patients had malignant disease detected in III-IV. In only 7 cases was treatment initiated in the first and second stages of the disease. In these patients, the tumors were removed with a safety margin of healthy tissue and in none, did the basic cancer recur . The postoperative course in terms of flap engraftment and overall condition of the patient was uneventful. All of these patients still enjoy a good life quality with a current mean survival in range 5 - 76 months. Radical surgical removal of a malignant tumor in the early stages of the disease is associated with fewer postoperative complications and longer survival. To avoid the risk of local and/or systemic postoperative complications, appropriate patient selection is important. Overall, the traditional, classic reconstructive procedures with the use of prostheses, in many cases is still the best option in our experience.

Highlights

Oropharyngeal cancers are among the 10 most frequent cancers in the world with increases every year of around 500,000 new cases
The tumors were removed with a safety margin of healthy tissue and in none, did the basic cancer recur
Except for one patient treated for Merkel cell carcinoma, all these patients had positive resection margins, and local and systemic complications of surgical treatment were common (Table 2)

Summary

Introduction

Oropharyngeal cancers are among the 10 most frequent cancers in the world with increases every year of around 500,000 new cases. About one third of patients survive 5 years following diagnosis. The percentage of these tumors in the Czech Republic is around 2% (3% in the USA, in the countries of Southeast Asia from 35 to 40%). Rational treatment of oropharyngeal cancers is complex and long. Selection of optimal treatment modalities depend on the biological nature of the tumor, its size and location. Patient age, overall health and stage of malignancy are of paramount importance

Results

Discussion

Conclusion