Pal Uma Shanker, Maurya Harshita, Yadav Shailendra Kumar, Kumar Vijay, Sowmya Meleti Venkata, Singh Ranjeet
Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of General Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
Ann Maxillofac Surg. 2023 Jan-Jun;13(1):88-94. doi: 10.4103/ams.ams_65_23. Epub 2023 Jul 31.
The objective of this study is to provide a structured protocol for the treatment of verrucous carcinoma (VC) based on size, bone invasion, recurrence and whether neck dissection is necessary or not. In addition, the study evaluates the probability of a wrong histopathological diagnosis.
A search was conducted in the Cochrane Library, PubMed and Google from January 1962 to October 2022 by using MeSH terms and keywords. Studies reporting treatment modalities for VC and different histopathological diagnoses after excision of the lesion were selected except case reports and review articles.
Thirteen articles were selected. Six hundred and thirty cases of VC were treated by surgery, surgery + neck dissection, radiotherapy, chemotherapy and combination therapy. Statistical analysis revealed surgical treatment as a preferred option. Despite being enlarged, the lymph node was negative for metastasis. So, in OVC cases neck dissection adds only unnecessary morbidity to patients.
Radiotherapy or chemotherapy can be used to downstage the disease. 23.3% of cases reported wrong histopathology diagnosis.
Patients treated for squamous cell carcinoma (SCC) will only experience unnecessary morbidity unless the correct diagnosis is made between VC and hybrid VC. Irrespective of size VC does not metastasise until there are no foci of SCC.
Surgical excision of T1- and T2-sized lesions can be performed under local anaesthetic as a biopsy procedure. T3 or T4 lesion can be resected with a safe margin. If it comes as hybrid VC or VC with close margin (0.5 cm, <0.5 cm), neck dissection and further margin should be excised as a second procedure respectively.
本研究的目的是根据疣状癌（VC）的大小、骨侵犯情况、复发情况以及是否需要进行颈部清扫，提供一种结构化的治疗方案。此外，该研究评估了组织病理学诊断错误的可能性。
于2022年10月，通过使用医学主题词和关键词，在Cochrane图书馆、PubMed和谷歌上进行了检索，检索时间范围为1962年1月至2022年10月。除病例报告和综述文章外，选取了报告VC治疗方式以及病变切除后不同组织病理学诊断的研究。
选取了13篇文章。630例VC患者接受了手术、手术+颈部清扫、放疗、化疗及联合治疗。统计分析显示手术治疗是首选方案。尽管淋巴结肿大，但转移呈阴性。因此，在口腔疣状癌（OVC）病例中，颈部清扫只会给患者增加不必要的发病率。
放疗或化疗可用于降低疾病分期。23.3%的病例报告存在组织病理学诊断错误。
除非在VC和混合性VC之间做出正确诊断，否则接受鳞状细胞癌（SCC）治疗的患者只会经历不必要的发病率。无论大小，VC在没有SCC病灶之前不会发生转移。
T1和T2大小的病变可在局部麻醉下作为活检手术进行切除。T3或T4病变可安全切缘切除。如果出现混合性VC或切缘接近（0.5cm、<0.5cm）的VC，应分别作为第二步手术进行颈部清扫和进一步切除切缘。
