Başerer Nermin, Damar Murat
Department of Otolaryngology, İstanbul University, İstanbul, Turkey.
Kulak Burun Bogaz Ihtis Derg. 2011 Nov-Dec;21(6):305-11. doi: 10.5606/kbbihtisas.2011.047.
To compare oncological, functional, clinical and cosmetic results of peroral resection and pull-through resection in early stage (T1, T2) tongue and floor of the mouth cancers.
Forty-nine patients (23 females, 26 males; mean age 54.4 years; range 21 to 87 years) with stage T1 and T2 oral tongue and floor of the mouth cancers primarily treated with peroral resection or pull-through resection techniques between 1998 and 2008 were included in this study. The data obtained during the study (clinical follow-up, tumor stage, type of surgery) were retrospectively evaluated, and the data obtained from patient follow-up (relapse, speaking, eating and drinking function, cosmetic appearance, patient satisfaction) were evaluated prospectively. Twenty-two patients were staged T1 and 27 patients were staged T2. Ten patients with stage T1 underwent pull-through resection, 12 patients with stage T1 underwent peroral resection. Sixteen patients with stage T2 underwent pull-through resection, 11 patients with stage T2 underwent peroral resection. Independent Samples T-test, One Way ANOVA test and Chi-Square test were used to compare these two resection techniques.
Cervical lymph node metastases were detected in 13 patients (27%) of 49 patients with early stage T1-T2 during postoperative histopathological evaluation. The difference was statistically significant in terms of recurrence in T2 tumors (p<0.05). The recurrence rate was 26% in patients who underwent peroral resection and 3.8% in patients who underwent pull-through resection with stage T1 and T2. Although there was no significant difference when comparing patient satisfaction, cosmetic appearance and postoperative complications, a significant difference was found for nasogastric tube and prophylactic tracheotomy applications in patients who underwent pull-through resection (p<0.05).
Pull-through resection is oncologically safer than peroral resection at the early stage (T1, T2) of floor of the mouth and oral tongue carcinomas. There was no significant difference between the two techniques concerning function and cosmesis.
比较早期（T1、T2）舌癌和口底癌经口切除与拖出式切除的肿瘤学、功能、临床及美容效果。
本研究纳入了1998年至2008年间主要采用经口切除或拖出式切除技术治疗的49例T1和T2期口腔舌癌和口底癌患者（23例女性，26例男性；平均年龄54.4岁；范围21至87岁）。对研究期间获得的数据（临床随访、肿瘤分期、手术类型）进行回顾性评估，对患者随访获得的数据（复发、说话、进食和饮水功能、美容外观、患者满意度）进行前瞻性评估。22例患者为T1期，27例患者为T2期。10例T1期患者接受拖出式切除，12例T1期患者接受经口切除。16例T2期患者接受拖出式切除，11例T2期患者接受经口切除。采用独立样本T检验、单因素方差分析和卡方检验比较这两种切除技术。
49例早期T1 - T2患者术后组织病理学评估发现13例（27%）有颈部淋巴结转移。T2肿瘤复发方面差异有统计学意义（p<0.05）。T1和T2期经口切除患者的复发率为26%，拖出式切除患者的复发率为3.8%。虽然比较患者满意度、美容外观和术后并发症时无显著差异，但拖出式切除患者的鼻胃管和预防性气管切开应用有显著差异（p<0.05）。
在口底癌和口腔舌癌的早期（T1、T2），拖出式切除在肿瘤学上比经口切除更安全。两种技术在功能和美容方面无显著差异。
