The authors review 62 case histories of patients treated surgically at the National Cancer Institute of Milan between 1955 and 1975, utilizing the transmandibular approach for ablative procedures for cancer of the tongue, lateral floor of the mouth, and amygdalo-palatoglossal region; the constant and characteristic feature of the whole series was uniformly of the surgical technic and of the indication for which it was used: extensive tumors without direct invasion of bone. Postoperative mortality was 5/62 (8%), with 4 deaths in 32 cases involving the amygdalopalatoglossal region (12.1%) and death in 29 cases involving the anterior region (3.4%). Death was caused by hemorrhage from rupture of carotid artery branches in 2 cases, and general complications in 3 cases. The overall incidence of complications was about the same whether the patients received radiation therapy or not; however, complications were more severe and longlasting in the former group. The mean hospital stay was the same for both groups of patients, namely 33 days (minimum 18, maximum 49 days). Functional sequelae amounted to severe and prolonged dysplasia in 3 patients, two of whom necessitated laryngectomy at a later date. The cosmetic and functional outcome was objectively more or less satisfactory; subjectively, however, all the patients were able to attain good adjustment to their status. The overall survival at 3 years was 35% for both localizations; survival at 5 years was 18.2%, this time with a definitely more favorable figure for the posterior localization (26,3% versus 7.1% for the anterior malignancies). In terms of indications, the 3-year survival was higher (40 and 43%) among patients treated for recurrences after irradiation than among those for whom ablative surgery was done first (30.8 and 16.7%); the 5-year survival was about the same (28.5 and 25%) among patients with posterior malignancies, and practically nil among anterior forms (only one case out of 14). The most common cause of failure was local recurrence (41.8%), alone (30%) or associated with N recurrence (11.6%). These recurrences were more frequent after anterior surgery (45%) than posterior (39%), and likewise in patients treated directly by ablative surgery (47.5%) than in those treated surgically after Rt followed by recurrence (37.5%). The incidence of histologically detected metastasis was high, namely 61.9% in the 42 cases so evaluated, with a peak of 68% in carcinomas of the amygdalo-palatoglossal region, as opposed to 53% in anterior carcinomas; in the former group, also, there was a high (40%) incidence of cases classified as N+R+. Recurrences of metastasis in the treated cervical gutter occurred in 9 of 43 cases (21%), and they were far more frequent (46.6%) among patients with capsular breakdown (N+R+). In patients without capsular breakdown (N+R-) the frequency of metastatic recurrence was about the same as in patients formerly without metastasis (9.1% as opposed to 6.2%). Contralateral metastases occurred in 8 patients; of these, only 3 specimens were secured for histological examination. Such metastases were more frequent in patients with posterior tumors (4 out to 25, or 16%) than in those with anterior malignancies (1 out of 17, or 6%). Overall, failures due to N were more frequent wih posterior than with anterior tumors (37% versus 27.7%). The data listed above suggest important changes of methodology and strategy of the therapeutic approach, which are currently being implemented.
|Translated title of the contribution||Indications and limitations of transmandibular surgery in carcinomas of the tongue, tonsils and pharynx|
|Title of host publication||Nuovo Archivio Italiano di Otologia Rinologia e Laringologia|
|Number of pages||16|
|Publication status||Published - 1978|
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