Liao Chun-Ta, Huang Shiang-Fu, Chen I-How, Chang Joseph Tung-Chieh, Wang Hung-Ming, Ng Shu-Hang, Hsueh Chuen, Lee Li-Yu, Lin Chih-Hung, Cheng Ann-Joy, Yen Tzu-Chen
Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Ann Surg Oncol. 2008 Aug;15(8):2187-94. doi: 10.1245/s10434-008-9980-4. Epub 2008 May 28.
The role of cheek skin excision in patients with squamous cell carcinoma of the buccal mucosa (BSCC) remains controversial. We sought to investigate when skin excision is needed to achieve an adequate local control.
A total of 331 patients with BSCC were reviewed. Skin preservation was pursued when the distance between the tumor and the skin as determined by imaging was >or=13 mm (1 cm surgical margin plus 0.3 cm skin preservation). Two hundred and thirty patients (69.5%) underwent skin excision. Postoperative adjuvant radiotherapy (n = 182) was performed in patients with pathological T4 disease, metastases in cervical lymph nodes or close pathological margins (<or=4 mm). The 5-year local control rate was plotted by Kaplan-Meier analysis.
Twenty-four patients (7.3%) had close pathological margins. The 5-year local control rate did not differ significantly between patients treated either with or without skin excision. This was verified both in subjects who received surgery alone (94% versus 91%) and in those who received surgery plus adjuvant therapy (82% versus 86%).
In patients with BSCC, a good 5-year local control rate may be equally achieved either with or without skin excision. In patients with pT3 disease, postoperative radiotherapy is not recommended in the absence of close pathological margins. Our findings may guide clinical decision-making on skin excision in this patient group.
颊黏膜鳞状细胞癌（BSCC）患者中颊部皮肤切除的作用仍存在争议。我们试图研究何时需要进行皮肤切除以实现充分的局部控制。
对331例BSCC患者进行了回顾性研究。当影像学检查确定肿瘤与皮肤之间的距离≥13 mm（1 cm手术切缘加0.3 cm皮肤保留）时，采取保留皮肤的方法。230例患者（69.5%）接受了皮肤切除。对病理T4期、颈部淋巴结转移或病理切缘接近（≤4 mm）的患者进行术后辅助放疗（n = 182）。采用Kaplan-Meier分析绘制5年局部控制率。
24例患者（7.3%）病理切缘接近。接受或未接受皮肤切除治疗的患者5年局部控制率无显著差异。这在单纯接受手术的患者（94%对91%）和接受手术加辅助治疗的患者（82%对86%）中均得到证实。
在BSCC患者中，无论是否进行皮肤切除，均可同样获得良好的5年局部控制率。对于pT3期患者，在不存在病理切缘接近的情况下，不建议进行术后放疗。我们的研究结果可为该患者群体皮肤切除的临床决策提供指导。
