Department of Head and Neck Surgery, European Institute of Oncology, Via Ripamonti 435, Milan, Italy.
Acta Otorhinolaryngol Ital. 2009 Oct;29(5):259-64.
The aim of curative surgical oncology is to remove the primary tumour with a wide margin of normal tissue. What constitutes a sufficiently wide margin particularly in oral cancer is fundamentally unclear. The currently accepted standard is to remove the primary lesion with a 1.5-2 cm circumferential macroscopic margin. In the last ten years, anatomical considerations in the approach to primary, advanced and untreated tumours of the tongue led us to develop and improve a new surgical approach to their demolition and reconstruction. From July 1999 to July 2009, at the European Institute of Oncology in Milano, Italy, 155 patients were treated, while defining and refining the concept of compartmental tongue surgery (CTS) and its main components: 1) anatomical approach to the disease that requires removal of the primary lesion and all of the potential pathways of progression--muscular, lymphatic and vascular; 2) identification of a distinct territory at risk of metastatic representation of the disease: the parenchymal structures between the primary tumour and the cervical lymphatic chain that include the muscular (mylohyoid), neuro-vascular (lingual nerve and vein) and glandular (sublingual and submandibular) tissues; 3) preparation for a rational reconstruction in consideration of a functional defect resulting from this anatomical demolition.
根治性外科肿瘤学的目的是用正常组织的宽边缘切除原发性肿瘤。特别是在口腔癌中，构成足够宽的边缘在根本上还不清楚。目前公认的标准是用 1.5-2 厘米的环周宏观边缘切除原发性病变。在过去的十年中，对舌部原发性、晚期和未经治疗的肿瘤的解剖学考虑促使我们开发和改进了一种新的手术方法来破坏和重建它们。1999 年 7 月至 2009 年 7 月，在意大利米兰的欧洲肿瘤研究所，对 155 名患者进行了治疗，同时定义和完善了分区性舌切除术（CTS）及其主要成分的概念：1）针对需要切除原发性病变和所有潜在进展途径（肌肉、淋巴和血管）的疾病的解剖学方法；2）识别疾病转移代表性的风险特定区域：原发性肿瘤和颈部淋巴链之间的实质结构，包括肌肉（下颌舌骨肌）、神经血管（舌神经和静脉）和腺体（舌下腺和颌下腺）组织；3）为考虑到这种解剖破坏引起的功能缺陷进行合理的重建做准备。
