Marhic A, Guerlain J, Benmoussa N, Breuskin I, Honart J-F, Janot F, Moya-Plana A, Temam S, Gorphe P
Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France.
Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France.
Int J Oral Maxillofac Surg. 2021 Sep;50(9):1123-1130. doi: 10.1016/j.ijom.2020.10.011. Epub 2021 Jan 5.
At the study hospital, the lip-split mandibulotomy (LSM) has progressively been replaced by a pull-through (PT) approach. This study compared the outcomes of the LSM and PT approaches in a series of 192 patients with T3-T4a oral tongue and floor of the mouth squamous cell carcinoma treated over the two last decades. No difference in margin status (P = 0.254), rate of early complications (local infections) (P = 0.867), haematoma/haemorrhage (P = 0.221), delayed wound healing (P = 0.438), re-operation (P = 0.083), or Clavien-Dindo classification (P= 0.5281) was found. The LSM approach was associated with a higher rate of late complications such as pseudarthrosis (14.5% vs 0.9%; OR 17.89, P = 0.0005) and trismus (35% vs 13.8%; OR 3.32, P = 0.025), and a trend towards a higher rate of fistulas (24.6% vs 13.1%; OR 2.16, P = 0.088). The quality of life of long-term survivors (median 132 months) was similar in the two groups, with a mean QLQC30 score of 59.7 (P = 0.099) and mean MDADI score of 57.4 (P = 0.213). The 5-year local control rate was 86.4% in the PT group and 86.2% in the LSM group (P = 0.878), while the 5-year overall survival rates were 50.0% and 48.3%, respectively (P = 0.68). In our experience, replacement of LSM by a PT approach in oral carcinoma was associated with decreased rates of late complications such as pseudarthrosis, fistula, and trismus, without any difference in oncological outcomes.
在研究医院，唇裂开下颌骨切开术（LSM）已逐渐被牵拉式（PT）手术方法所取代。本研究比较了LSM和PT两种手术方法对过去二十年中收治的192例T3 - T4a期口腔舌癌和口底鳞状细胞癌患者的治疗效果。结果发现，两组在切缘状态（P = 0.254）、早期并发症（局部感染）发生率（P = 0.867）、血肿/出血（P = 0.221）、伤口愈合延迟（P = 0.438）、再次手术（P = 0.083）或Clavien - Dindo分级（P = 0.5281）方面均无差异。LSM手术方法与较高的晚期并发症发生率相关，如假关节形成（14.5%对0.9%；OR 17.89，P = 0.0005）和牙关紧闭（35%对13.8%；OR 3.32，P = 0.025），并且瘘管发生率有升高趋势（24.6%对13.1%；OR 2.16，P = 0.088）。两组长期存活者（中位生存期132个月）的生活质量相似，QLQC30平均评分为59.7（P = 0.099），MDADI平均评分为57.4（P = 0.213）。PT组的5年局部控制率为86.4%，LSM组为86.2%（P = 0.878），而5年总生存率分别为50.0%和48.3%（P = 0.68）。根据我们的经验，在口腔癌中用PT手术方法取代LSM与假关节形成、瘘管和牙关紧闭等晚期并发症发生率降低相关，而肿瘤学结局无差异。
