Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea.
Oral Oncol. 2017 Oct;73:70-76. doi: 10.1016/j.oraloncology.2017.08.005. Epub 2017 Aug 18.
To investigate the clinical usefulness of transoral bisected resection (TBR) asa new method to secure adequate deep resection margin in T1-2 oral tongue squamous cell carcinomas (SCC).
Among 75 patients with cT1-2N0 oral tongue SCCs, 45 (60%) received transoral en-bloc resection (TER) while 30 (40%) received patients underwent TBR. Primary tumor resection was performed with 1.5-cm surgical resection margin for both groups. Mucosal and deep resection margins, adjuvant treatments including re-resection of the tongue and cheomoradiotherapy, local and regional recurrence free survival, and overall survival were compared between the two groups.
Mean deep resection margin in the TBR group was 9.9mm (95% CI: 8.4-11.4mm), which was significantly (P<0.001) wider than that of the TER group (mean: 5.4mm, 95% CI: 4.5-6.3mm). However, mucosal resection margins were not significantly (P=0.153) different between the two groups. Re-resection of tongue was performed for 6 (13.3%) of 17 (37.8%) patients with inadequate deep resection margin in the TER group and none (0%) in 4 (13.3%) patients with inadequate deep resection margin in the TBR group. Adjuvant radiation due to inadequate deep resection margin was performed for 6.7% of patients in both groups. The TBR group had better local recurrence free survival than the TER group. However, regional recurrence free survival and overall survival were not significantly different between the two groups.
TBR could provide adequate deep resection margin for early stage tongue cancers with better local tumor control than TER. It can decrease the necessity of adjuvant treatment for re-resection of the tongue.
为了研究经口双侧分块切除术（TBR）作为一种新方法在确保 T1-2 期口腔舌鳞癌（SCC）充分切缘深度方面的临床应用价值。
在 75 例 cT1-2N0 口腔舌 SCC 患者中，45 例（60%）接受经口整块切除术（TER），30 例（40%）接受 TBR。两组均采用 1.5cm 手术切缘进行原发肿瘤切除术。比较两组的黏膜和深部切缘、包括舌再切除术和放化疗在内的辅助治疗、局部和区域无复发生存率以及总生存率。
TBR 组的平均深部切缘为 9.9mm（95%CI：8.4-11.4mm），明显（P<0.001）大于 TER 组（平均：5.4mm，95%CI：4.5-6.3mm）。然而，两组的黏膜切缘无明显差异（P=0.153）。TER 组中 17 例（37.8%）深部切缘不足的患者中有 6 例（13.3%）进行了舌再切除术，而 TBR 组中 4 例（13.3%）深部切缘不足的患者中无一例（0%）进行了舌再切除术。两组均有 6.7%的患者因深部切缘不足而接受辅助放疗。TBR 组的局部无复发生存率优于 TER 组。然而，两组的区域无复发生存率和总生存率无明显差异。
TBR 可为早期舌癌提供足够的深部切缘，与 TER 相比可更好地控制局部肿瘤。它可以减少因舌再切除术而进行辅助治疗的必要性。
