Saldanha Elroy, Desai Sanjay M, Patel Dhruv G, Dhakad Vinod, Joseph Bonny, Ghosh Sandeep
Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, MP India.
Indian J Surg Oncol. 2021 Dec;12(4):722-728. doi: 10.1007/s13193-021-01417-2. Epub 2021 Aug 19.
Patients with advanced carcinoma tongue in the Indian subcontinent have an additional component of submucosal fibrosis (SMF) due to chewing of betel. We intend to evaluate mandibular pull-through approach for total or near-total glossectomy and assessed its functional and survival outcome. Prospective study of 77 patients with carcinoma tongue, who underwent total or near-total glossectomy at our institute, were assessed retrospectively. All the patients who underwent glossecomy through mandibular pull through approach with pedicled or free flap reconstruction were assessed for functional and survival outcomes. Of the 77 patients, 45 (58.44%) patients underwent total glossectomy, while 32 (41.55%) patients near-total glossectomy, 61 (79.22%) cases had operative time ≤ 30 min, 69 (89.61%) patients had margins of > 5 mm, and none of the margins were involved. Flaps were reconstructed with 42 (54.54%) PMMC, 24 (31.16%) FRAFF, and 11 (14.28%) ALT. Five (6.49%) patients had surgical site infections, 6 patients each had to undergo re-explorations and partial flap loss, 7 patients had oro-cutaneous fistula, while 53 (68.83%) patients had no complications/osteoradionecrosis. A total of 94% of patients underwent decannulation, 92% of patients got discharged, and 89% got NG tube removed within 21 POD. Forty patients had reasonably good speech. On the long-term follow-up, 9% of the patients developed local recurrence and 11% of patients had regional/lymph node recurrence. Mandibular pull-through approach had the advantages of good accessibility to the tumour with the least mutilating techniques with shorter operation time, lower rates of postoperative complications, and better aesthetics and based on available data, it is superior to the mandibular lip-spilt surgery for advanced tongue involving BOT and floor of mouth cancers when coupled with SMF surgeries for the Indian scenario.
在印度次大陆，晚期舌癌患者因咀嚼槟榔而存在黏膜下纤维化（SMF）这一额外因素。我们打算评估下颌骨牵开入路行全舌或近全舌切除术，并评估其功能和生存结果。对在我们研究所接受全舌或近全舌切除术的77例舌癌患者进行了回顾性评估。对所有通过下颌骨牵开入路行舌切除术并采用带蒂或游离皮瓣重建的患者进行了功能和生存结果评估。77例患者中，45例（58.44%）接受了全舌切除术，32例（41.55%）接受了近全舌切除术，61例（79.22%）手术时间≤30分钟，69例（89.61%）切缘>5毫米，且切缘均未受累。皮瓣重建采用42例（54.54%）胸大肌肌皮瓣、24例（31.16%）游离桡动脉前臂皮瓣和11例（14.28%）股前外侧皮瓣。5例（6.49%）患者发生手术部位感染，6例患者分别接受了再次探查和部分皮瓣坏死，7例患者发生口皮瘘，而53例（68.83%）患者无并发症/放射性骨坏死。共有94%的患者拔管，92%的患者出院，89%的患者在术后21天内拔除鼻饲管。40例患者言语功能较好。长期随访中，9%的患者发生局部复发，11%的患者发生区域/淋巴结复发。下颌骨牵开入路具有以下优点：以最少的致残技术良好地暴露肿瘤，手术时间短，术后并发症发生率低，美观效果好，并且根据现有数据，对于涉及舌根和口底癌且伴有SMF的印度晚期舌癌患者，与下颌唇裂手术相比，它更具优势。
