Surgical Treatment Of Oral Cancer Research Articles

Retrospective analysis on prognosis of oral cancer patients according to surgical approaches for effective cancer ablation: swing approach versus visor approach

BackgroundFor the surgical treatment of oral cancer, it is sometimes necessary to expand intraoral access within the oral cavity. The “swing approach” that involves lip splitting of the mandible and temporary mandibular osteotomy and the “visor approach” that does not split the lower lip and mandible are mainly used. This study analyzed postoperative outcomes such as complications, recurrence rate, and survival rate by these two approaches. The goal of this study is to evaluate the surgical outcomes of patients using these two approaches, to propose effective perioperative management for oral cancer surgery, and to compare the prognosis of oral cancer patients.Materials and methodsFrom 2005 to 2020, 29 patients who underwent surgery at the Department of Oral and Maxillofacial Surgery of Pusan National University Dental Hospital for oral cancer lesions occurred in the mandible, floor of mouth, and tongue were selected for the study. Based on the surgical approach used, a chart review was conducted on various prognostic clinical factors such as the patients’ sex and age, primary site, TNM stage, histopathologic grade, recurrence and metastasis, postoperative survival rate, adjuvant chemo-radiation therapy, satisfaction with aesthetics/function/swallowing, length of hospital stay, tracheostomy and its duration, and neck dissection and its type. Statistical analysis was conducted using SPSS 25.0 (SPSS Inc., Chicago, IL) through Fisher’s exact t-test.ResultThere was no statistically significant difference between two groups in terms of clinical and pathological findings, such as survival rate, the need for adjuvant therapies, and the local recurrence rate. Although better outcomes were observed in terms of function, aesthetics, and postoperative complications in the group with visor approach, there was still no statistically significant difference between two groups. However, the duration of hospital stay was shorter in the visor approach group.ConclusionThere was no statistically significant difference in clinical prognostic factors between the swing approach and the visor approach. Therefore, when choosing between the two approaches for the ablation of oral cancer, it is considered to select the surgical priority approach that can be easy access based on the size and location of the lesion. The visor approach had advantages of aesthetics and healing period.

Dental rehabilitation in irradiated oral cancer patients using patient-specific dental implants – Clinical outcome and oral health-related quality of life

IntroductionDental rehabilitation in oral cancer patients is essential for good oral health-related quality of life (OHRQoL). Patient-specific dental implants are suitable for treating tumor-related bony defects, resulting in satisfactory OHRQoL. However, knowledge concerning the clinical outcome and OHRQoL following tumor irradiation is lacking. Material and MethodsA retrospective analysis was carried out to evaluate clinical outcomes and OHRQoL in eight patients who received patient-specific dental implants and implant-supported dentures after surgical treatment for oral cancer with additional irradiation. OHRQoL assessment was performed using the German long version of the oral health impact profile (OHIP) questionnaire (OHIP-G53). ResultsClinical examination revealed successful dental rehabilitation in all the patients with only minor impairments. Restricted stability and function of implants were not observed. OHIP sum-scores of all the patients indicated acceptable OHRQoL, but this varied between patients treated in the upper or lower jaw. Single-item sum-scores concerning the adverse events “difficulty in chewing,” “food catching,” “sore jaw,” “sore spots,” and “unclear speech” were detected to be the worst, and pain-related OHIP dimensions demonstrated the highest scores (followed by functional limitation, physical disability, and psychosocial impact) with a worse OHRQoL following lower jaw treatment. Other dimension sum-scores were overall lower and nearly equally distributed in patients. ConclusionsDental rehabilitation of irradiated oral cancer patients using patient-specific dental implants may be suitable, leading to acceptable OHRQoL. However, implant insertion in the upper jaw seems to be more favorable. Further studies on patient-specific dental implants are warranted to validate the current results.

Pathological tumor volume as a simple quantitative predictive factor of survival in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the eighth most common type of cancer in the world. Knowledge of prognostic factors of survival in OSCC is key. Several clinical and pathological prognostic factors have been investigated to develop a prognostic model of survival for patients with oral cancer. The present study focused on the association between pathological tumor volume (PTV) and overall survival time in patients with OSCC, regardless of cervical nodal status. The present study was a prospective study and covered 65 consecutive patients who received surgical treatment for oral cancer. The PTV was calculated according to dimensions of the postoperative specimen. Other pathological parameters as perineural and perivascular tumor spreading and extra-nodular propagation were also determined. The data were analyzed using the IBM SPSS 25.0 software. Cox PH regression model was built to analyze association between the PTV and survival time. Survival time was defined as the period from surgery to a target event or last contact. The results of the present study showed that PTV >4.24 cm3 was significantly associated with shorter overall survival time in patients with OSCC. The PTV value was higher in patients with metastasis and in patients with higher pathological tumor and node stage. In conclusion, PTV was an important pathological prognostic factor for survival in patients with OSCC.

Objective speech outcomes after surgical treatment for oral cancer: An acoustic analysis of a spontaneous speech corpus containing 32.850 tokens

IntroductionSurgical treatment for oral cancer leads to lasting changes of the vocal tract and individuals treated for oral cancer (ITOC) often experience speech problems. The purpose of this study was to analyse the acoustic properties of the spontaneous speech of individuals who were surgically treated for oral cancer. It was investigated (1) how key spectral measures of articulation change post-treatment; (2) whether changes are more related to target manner or place of articulation; and (3) how spectral measures develop at various time points following treatment. MethodA corpus consisting of 32.850 tokens was constructed by manually segmenting the speech of five (four female - one male) American English speaking ITOC. General acoustic characteristics (duration and spectral tilt), plosives (burst frequency), fricatives (centre of gravity and spectral skewness), and vowels (F1 and F2) were analysed using linear mixed effects regression and compared to control speech. Moreover, a within speaker analysis was performed for speakers with multiple recordings. ResultsManner of articulation is more predictive of post-treatment changes than place of articulation. Compared to controls, ITOC produced the fricatives /f, v, θ, ð, s, z, ʃ, ʒ/ with a lower centre of gravity while no differences were found for plosives and vowels. Longitudinal analyses show high within-speaker variation, but general improvements one-year post-treatment. ConclusionsSurgical oral cancer treatment changes the spectral properties of speech. Fricatives with varying manner of articulations were distorted, suggesting that manner of articulation is more predictive than place of articulation in identifying general problem areas for ITOC.

Socio-demographic aspects and treatment-related factors on oral cancer patients' participation in rehabilitation.

Objectives: After resection of an oral carcinoma, patients are faced with physical, psychological, and socioeconomic challenges. Rehabilitation plays an essential role in patients’ reintegration into their social and professional environment. This study evaluated whether socioeconomic aspects affect oral cancer patients’ participation in rehabilitation treatment. Materials and methods: A retrospective analysis was conducted with 1,532 patients following surgical treatment of oral cancer during an international multicenter rehabilitation study of the German-Swiss-Austrian Cooperative Working Group on Maxillofacial Tumors using a questionnaire comprising disease-related and psychosocial items postoperatively and at least 6 months after surgery.Results: Only 35.4% of patients participated in rehabilitation. Age (p<0.001), sex (p<0.001), and marital status (p<0.05) significantly influenced participation in rehabilitation. Postoperative impairment (p<0.05) as well as quality of life (p<0.01) were significantly worse in patients who participated in rehabilitation. Nevertheless, this group of patients returned to work significantly more often, although later, than those who did not participate in rehabilitation (p<0.05). Conclusions: The findings show social inequalities and suggest a general undersupply of rehabilitative follow-up treatment in patients with oral cancer. More patients, especially older people and women should be referred to rehabilitation.

A prospective randomized comparative trial evaluating postoperative nutritional intervention in patients with oral cancer

Extensive surgical treatment of oral cancer results in significant deterioration of nutritional status with concomitant increased nutrient requirements. The consequences are an elevated risk of postoperative complaints as well as morbidity and mortality. The aim of this study was to investigate an additional postoperative nutritional intervention through professional nutritional advice and nutritional supplementation in patients with oral cancer for at least six months. 62 patients with oral cancer in the department of oral and maxillofacial surgery were randomized into two groups. The intervention group received nutritional supplements, protein-rich, high-fiber diet and care by a professional nutritionist in addition to the standard treatment. The control group received only the standard treatment. Statistical analysis includes the evaluation of means and standard deviations as well as the calculation of p values with a significance level of 0.05. A deficiency of protein, albumin, vitamin D, zinc and iron was noticed in both groups immediately after surgery. Patients in the intervention group recorded significantly less weight loss (pT2 = 0.0031, pT4 = 0.0424), a more stable BMI (pT2 = 0.0496), better values for albumin (pT2 = 0.0265), vitamin A (pT3 = 0.0248, pT4 = 0.0007) and calcium (pT3 = 0.0362) during the follow-ups. The patients in the intervention group showed significantly fewer digestive problems (p = 0.0062) and muscular complaints (p = 0.0448). They showed better eating habits (p = 0.0348) and were capable of more physical activity (p = 0.0045) than patients in the control group. Patients with oral cancer can have a benefit from postoperative nutritional intervention. Early screening, appropriate care by a nutritionist and supplementation with vitamin D, zinc, calcium and protein-rich food are recommended.

Oral cancer and bucco-maxillo-facial surgery: a systematic review of clinical findings

Introduction: In the context of oral cancer management, it is a multidisciplinary effort, as each patient presents physicians with a unique set of challenges whose management impacts both survival and quality of life. Oral and maxillofacial surgery remains the mainstay of treatment. Oral cancer (OC) has a high incidence and mortality and is among the 10 (ten) most common pathologies in the world, Brazil today represents alarming public health. OC awareness is low, especially in terms of knowledge of signs and symptoms. Also, self-examination is relatively fast, inexpensive, and simple to perform. The diagnostic accuracy of the oral self-examination needs to be established first before advocating it as a potential screening tool for early detection. Objective: the present study aimed to carry out a systematic review of the main clinical findings on the surgical treatment of oral cancer by dentists. Methods: The rules of the Systematic Review-PRISMA Platform. The research was carried out in December 2021 to February 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 243 articles were found. In total, 104 articles were fully evaluated and 25 were included and evaluated in this study. there was a positive impact of CAD/CAM mandibular reconstruction on mastication and swallowing function after surgery for locally advanced oral cancer for the first time. Therefore, neoadjuvant chemotherapy plays a potential role in mandibular preservation in oral cancers with acceptable toxicities and without compromise in survival. The low prevalence of oral self-examination was more common among the elderly, being more common to oral cancer. Thus, educational actions can influence people's self-perception of their oral condition. In this way, the studies showed that to achieve the success of the surgical treatment of oral cancer, it is necessary for the individuals themselves to expand the self-examination care, linked to the evaluation and early diagnosis of dental surgeons. Conclusion: The studies showed that to achieve the success of the surgical treatment of oral cancer, it is necessary that self-perception of oral health, one of the components of quality of life, refers to a subjective experience of the individual about their functional, social and psychological well-being.

Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts: A New Approach for Intraoral Defect Reconstruction.

Free flap transfer for reconstruction of intraoral defects is a common procedure in oral and maxillofacial surgery. For tumor-related defects, the radial forearm flap is widely used for soft tissue restoration. However, transfer of free skin grafts to the donor site region is often required for wound closure after free flap harvesting, resulting in esthetic disturbances due to shrinkage of the grafted skin, attendant scarring, or mismatches in skin texture or color. Furthermore, free flap transfer may result in hair follicle transfer into the oral cavity, causing unfavorable intraoral hair growth in adult men in particular. Free flap prelamination can help reduce the potential disadvantages of free flaps, in terms of both flap design and size and donor site morbidity. For surgical treatment of oral cancer in middle-aged and elderly patients, eyelid dermatochalasis may present as a comorbidity leading to esthetic impairments or, in cases involving the upper eyelid, even a reduced field of view. In these cases, bilateral blepharoplasty can reduce the excess eyelid skin. The present study is the first to attempt to use excised skin after bilateral blepharoplasty as full-thickness skin grafts for radial forearm free flap prelamination. This approach combined surgical therapy of eyelid dermatochalasis with free flap prelamination, thereby avoiding the need to harvest free skin grafts from other anatomically healthy regions to close the donor site defect and preventing the accompanying disadvantages. The reconstruction results and clinical outcomes of patients revealed that radial forearm free flap prelamination using bilateral free full-thickness eyelid skin grafts was an easy and feasible method for intraoral defect reconstruction. In particular, this approach could avoid intraoral hair growth and additional skin grafting from other healthy anatomical regions, yielding good esthetic and functional results at the flap's recipient and donor sites.

Preoperative determination of tumor thickness in oral squamous cell carcinoma by computed tomography

Introduction. Evaluation of the prognostic factors and the survival rate in oral squamous cell carcinoma is extremely important, because patients in the same tumor-node-metastasis stage may have a different survival rate. Numerous studies have been conducted on various clinical and pathological prognostic factors in order to develop a prognostic model for the survival rate of patients with oral cancer. Material and Methods. The study was designed as a prospective study including 65 consecutive patients (n = 65) of both sexes who underwent surgical treatment of oral cancer. The diagnosis of oral cancer was based on the medical history, physical examination, and biopsy. The clinical tumor-node-metastasis staging was determined based on clinical examination. The radiological tumor-node-metastasis staging was done by computed tomography of the head, neck, and chest. The tumor thickness was determined by computed tomography and histopathological analysis of surgical specimens. Results. The histopathological analysis showed a mean tumor thickness of 13.446 mm, while the mean computed tomography tumor thickness was 15.2707 mm. The correlation between computed tomography tumor thickness and histopathological tumor thickness was moderately significant (Spearman?s rho = .581, p = 0.000). Conclusion. This study supports the use of computed tomography in the determination of tumor thickness in patients with oral squamous cell carcinoma. We want to emphasize the importance of preoperative, detailed imaging evaluation of patients in order to avoid multiple surgical procedures, significant morbidity, and unnecessary costs.

Design of an Artificial Tongue Driven by Shape Memory Alloy Fibers.

Dysphasia is one of the complications which may cause functional disability after the surgical treatment of oral cancer. The loss of the function derived by tongue and other oral tissues impairs the retention and delivery of liquids and food masses as well as the swallowing motion into pharynx. As accumulation of liquids or food masses in the larynx can lead to pneumonia, therefore swallowing support to improve each coordination of the tongue, the epiglottis and the esophagus in the process of swallowing is highly desirable. In this study, we designed a new artificial tongue which was capable of contracting to deliver the bolus masses in the swallowing propulsion phase in the oral cavity. We designed a two-layered artificial tongue simulating the anatomical identical muscle structures with the longitudinal muscle, and the transverse muscle-genioglossus layer. A silicone rubber material was used for the surface layer, and the covalent shape memory alloy fibers (diameter: 150µm) were implemented in the secondary structure beneath of the silicone rubber material of the artificial tongue. Its contraction was driven by with shape memory alloy fibers shortage inside of the artificial tongue unit. The actuation was accurately controlled by the originally designed electrical current input with pulse width modulation. Firstly, we examined a prototype structure of the artificial tongue as well as the changes in unit thickness as it constricted by electric power supply switching. Secondly, we performed a feasibility study of the prototype into the head-neck medical training model with larynx-tracheal structure with esophagus. The results were as follows: a) the artificial tongue model showed a large contraction with a motion to increase upward pressure, b) the tongue unit expressed the capability of reducing shallow space between dorsal tongue surface and palate in the oral cavity model. Therefore, the first artificial tongue design with active contractile motion will be useful orally installable device for improving delivery function of bolus masses through swallowing procedure in dysphasia.Clinical Relevance- The active artificial tongue system designed for the first time exhibited an effective contractile motion to support bolus food masses propulsion in swallowing process in the oral cavity in the patients with dysphasia.

P-159 Outcomes of nasolabial flap reconstruction for oral defects in surgical treatment of oral cancer

P-159 Outcomes of nasolabial flap reconstruction for oral defects in surgical treatment of oral cancer

P-158 Outcomes of submental flap reconstruction fororal defects in surgical treatment of oral cancer

P-158 Outcomes of submental flap reconstruction fororal defects in surgical treatment of oral cancer

Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience.

Backgrounds:Oral squamous cell cancer (SCC) is one of the most common cancers. The most common age of presentation is fifth to sixth decade. Management of this disease is dictated by stage, age, and related comorbidities. Elderly patients have their own set of limitations as far as their management is concerned. Carcinoma involving central mandibular arch is a challenging disease for surgeons, especially in the elderly. This article describes our experience with the surgical treatment of oral cancer involving the central arch of the mandible in elderly patients.Methods:Forty elderly (≥60 years) patients with histologically proven SCC of the oral cavity in which disease was involving the central arch of the mandible, were included in our study. Demographic, clinical, and treatment-related factors were recorded. The outcome was assessed in terms of postoperative complications, recurrence, and patient survival.Results:The median age of the patients was 63 years. The male:female ratio was 7:3. A history of oral tobacco use was present in 95% of patients. The most common site of disease was lower alveolus (80%) followed by carcinoma of the lower lip (20%). Majority of our patients (77.3% [30]) were having Stage IV disease. Mandibulectomy was either segmental (62.5%) or marginal (37.5%). Bilateral neck dissection (37/40, 92.5%) was done in most patients. Among all patients, 62.5% (25) received adjuvant radiotherapy. The local recurrence rate after a median follow-up of 30 months was 15% (6). Two-year disease-free survival and overall survival were 89% and 90%, respectively.Conclusion:Central arch of the mandible is a difficult disease to treat. It needs a complex and lengthy reconstructive procedure. Comorbidities such as extreme age, diabetes, and pulmonary and cardiac illnesses make it more challenging to manage. With the proper evaluation of comorbidities and avoiding long, cumbersome procedures, we can provide patients a fairly good chance of survival.

Is Preoperative Plate-Lymphocyte Ratio a Predictor of Deep Vein Thrombosis in Patients With Oral Cancer During Surgery?

Detecting deep vein thrombosis (DVT) is necessary to reduce the morbidity of venous thromboembolism, and platelet-lymphocyte ratio (PLR) is a novel marker for predicting DVT. This study aimed to investigate the association between preoperative PLR and risk of developing DVT in patients receiving surgical treatment of oral cancer. We designed a retrospective cohort study, and the source of study sample was patients with oral cancer and who underwent surgery between 2015 and 2019. Patients were excluded if they did not undergo surgical treatment and had preoperative DVT and history of hypercoagulable disorders. The primary predictor variable was PLR. We calculated the receiver operating characteristic curve and area under the curve to determine the best-defined risk groups. The best cutoff value for PLR was 187.4 (area under the curve, 0.772; sensitivity, 75.0%; specificity, 74.2%; P=.002). The primary outcome variable was DVT, and the other variables were patient characteristics, blood examination data, and therapeutic data. A logistic regression analysis was used to adjust the effects of potential confounders. A total of 101 patients were included in this study, and DVT was observed in 12 (11.9%) patients. Free flap reconstructive surgery was performed in 8 of the 12 (66.7%) patients in the DVT group. Statistical analyses showed that DVT was significantly associated with PLR (≤187.4 vs >187.4; P=.001). Logistic multivariate analysis of the preoperative parameters identified the following 2 independent predictive factors for DVT: PLR (≤187.4 vs >187.4) (odds ratio, 13.735; 95% confidence interval, 2.950 to 63.944; P=.001) and free flap reconstructive surgery (odds ratio, 6.584; 95% confidence interval, 1.504 to 28.822; P=.012). High PLR (>187.4) and free flap reconstructive surgery, considered as preoperative predictive factors, were associated with DVT.

Diagnostic Accuracy of Lugolâs Iodine Staining in Detection of Safe Margins of Oral Squamous Cell Carcinoma

Background and objectives: The successful surgical treatment of oral cancer depends upon the stage of disease at diagnosis and adequate resection of tumor. Residual disease after surgery is responsible for early recurrence and poor prognosis. Complete removal of lesion with adequate safe margins is therefore of paramount importance. A variety of aids are used to ensure the complete removal of lesion. The present study was aimed to determine the diagnostic accuracy of Lugol’s iodine staining in detection of safe margins of oral squamous cell carcinoma, taking histopathology as gold standard. Patients and methods: This study was conducted in the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore. Data was collected from 50 patients using non-probability sampling technique. After informed consent, appropriate pre-operative preparation was done. Diagnosed cases of oral squamous cell carcinoma were included in the study. All patients were treated under general anesthesia. Staining with Lugol’s iodine was done and margins were taken as guided by the staining pattern. Histolopathologic examination of margins was done and results of clinical staining and histopatholgoic reports were recorded. Results: The most common site of occurrence was buccal mucosa (n=20), followed by tongue (n=12) and lower vestibule (n=9). Other less common sites were upper vestibule (n=4), lip (n=3) and maxillary sinus (n=2). A 2X2 contingency table was generated for sensitivity, specificity, positive predictive value, and negative predictive value by using staining pattern and histopathology reports. Sensitivity of Lugol’s iodine was 91 % and specificity was 92.3%. Positive predicative and negative predictive values were 77% and 92% respectively. Conclusion: Lugol’s iodine is one of the diagnostic adjuncts that can be effectively used for detection of safe margins of oral squamous cell carcinoma as it is a simple, cost effective, noninvasive, and quick with good diagnostic accuracy.

Pectoralis Major Myocutaneous Flap Reconstruction with Deltopectoral Flap Incision in the Surgical Treatment of Oral Cancer

Background: One of the main goals of patient management is the reconstruction of tissue defects following surgical resection for oral cancer. A variety of flaps used for this purpose, the most frequent being a Pectoralis Major Myocutaneus Flap (PMMF). This flap is currently widely used for the reconstruction of different defects of the head and neck. Methods: Surgical resection of the primary tumor, as well as neck dissection, performed on 29 patients with oral squamous cell carcinoma between 2011–2017 in City Hospital #1 and Surgical Training Clinic of Azerbaijan Medical University. PMMF used for the reconstruction of defects using a deltopectoral flap incision. Results: In 22 patients (75.8 %) primary healing occurred following a PMMF. Four patients (13.8 %) suffered PMMF necrosis and were took back to the operating room for secondary reconstruction with a deltopectoral flap. In three patients (10.3%) the skin of the flap underwent necrosis, resulting in the development of an orocutaneous fistula. Conclusion: Use of PMMF with deltopectoral flap incision enables deltopectoral flap availability. This flap can then used early on or if PMMF fails.

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.

THE USE OF SUBMENTAL LOCAL FLAP AND RADIAL FREE FLAP FOR THE RECONSTRUCTION OF DEFECTS IN PATIENTS WITH ORAL CANCER

Introduction.Due to anatomical features, surgical treatment of oral cancer can lead to significant functional and esthetic defects. Main methods of reconstruction can be divided into groups of local and free flaps. There are lots of publications devoted to reconstruction of defects of oral cavity with the use of local and free flaps, but only few of them contain the comparison of these methods in the aspect of functional results.Materials and methods.A total of 58 patients with oral cancer were included in our study. All patients received surgical treatment with one-time reconstruction of defect. In 34 cases we used free radial flap and in 24 – submental local flap.Results.The use of submental flap has advantages in the intraoperative time, time of recovery, functional results, with the same locoregional control.Conclusions.We suggest submental local flap and radial free flap to be the method of choice in reconstruction of mucosa and soft tissues defects in patients with primary and recurrent oral cancer.

Impact of a reconstructive stage on the postoperative course in patients with oral cancer

The study objectiveis to assess effect of the reconstructive stage on the course of the postoperative period in patients with oral cancer.Materials and methods.A retrospective analysis of medical records of 174 patients (121 men and 53 women) aged 36 to 84 years (average 58.26 ± 8.72 years) with oral cancer undergoing treatment from January 2009 to June 2016 was performed. Depending on the nature of the reconstructive stage, the patients were divided into 3 groups. The group 1 consisted of 59 patients, to eliminate the defects of which flaps were taken on axial blood supply, the group 2 included 83 patients who had a reconstructive phase of the operation included a microsurgical reconstruction; 32 patients who had not used additional plastic material to eliminate the defect made up the control group. The following parameters were taken as evaluation parameters: the duration of the operation and hospitalization, the time spent in the intensive care unit, the frequency of serious and frivolous complications. The criterion for distinguishing serious and unserious complications is the fact that the patient returned to the operating room.Results.The reconstructive stage increased the operation duration by 72.12 min in the group 1 and by 285.72 min in the group 2, the length of stay in the intensive care unit – by 0.67 and 2.58 days, respectively, the hospital stay – by 33.9 and 40.4 %. The incidence of complications was higher in the groups 1 and 2 than in the control (6.6 %), and the type of reconstruction had almost no effect on it (42.37 % in the group 1 and 38.55 % in group 2). The frequency of serious complications was higher in the group 2, the frequency of partial flap necrosis – in the group 1.Conclusion.The inclusion of a reconstructive stage into the protocol of surgical treatment for oral cancer is absolutely reasonable, because it gives the patients a chance to return to their normal lives. Microsurgical reconstruction is a costly and labour-consuming procedure; however, it has almost the same number of complication as reconstructive surgery with flaps with an axial blood supply.

Factors associated with post operative complications in oral carcinoma: prospective study

Introduction: Patients who require surgery to treat head and neck cancer are at higher risk of perioperative complications and this scenario is not different for patients with malignant tumors of the oral cavity. Thus, the objective of the present study was to identify preoperative prognostic factors related to postoperative complications in the surgical treatment of oral cancer. Methods: Prospective study with 43 consecutive squamous cell carcinomas of the oral cavity submitted to surgical treatment with curative intent. Results: Seventeen patients presented postoperative complications until the thirtieth day of follow-up, of which 17.6% required surgical reoperation. The most common complications were suture dehiscence and surgical site infections. Alcohol abuse (p=0.004), pT4a tumors (p=0.044), tumors with thickness greater than 10 mm (p=0.002), patients with mGPS score 1 and 2 (p=0.027) and flap reconstruction (p <0.001) were associated with higher rates of postoperative complications. To the multivariate analysis, patients with tumor thickness greater than 10 mm (HR=11,240, 95% CI: 1,052-120,059, p=0.045 - logistic regression) and reconstructed with myocutaneous flap (HR=18,415, 95% CI: 1,849-183,359, p=0.013 - logistic regression) had a higher risk of developing postoperative complications. Conclusion: Tumor thickness greater than 10 mm or use of myocutaneous flaps in the reconstruction were the predictors of risk of postoperative complications in patients with squamous cell carcinoma of the oral cavity.