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PubMed2001

[Recognizing of the transglottic carcinoma].

OBJECTIVE: A study was undergone about transglottic carcinoma(TGC) in eighty six cases from 1979 to 1998, so as to recognize the TGC. METHOD: Evaluating retrospectively the procedure of the disease, surgical operations, presence of cervical metastasis, gathering the data on histopathological discovery and following up and so on. RESULT: The TGC was different from T2, T3 supraglottic or glottic carcinoma of larynx. In 86 TGC, there were 63 cases which were operated with total laryngectomy, 9 cases subtotal laryngectomy and 14 cases frontolateral hemilaryngectomy, 47 cases with neck dissection. In TGC which size > 2 cm, there were 58% which extend to the framework of larynx, 46% with extension out of larynx, and 71% with neck metastasis. The result of following up shows that 5-year survival rate was 55.41%, 10-year was 29.72%, 15-year and more was 18.92%. CONCLUSION: There is an actual signification for TGC to be a special type of the laryngeal carcinoma. The characteristics of the precise topography of the the paraglottic space (PGS) can explain the reason of extension, spread of the TGC and cervical metastasis. Elective neck dissections and complemental radiotherapy postoperatively should be included during surgical resection.

Adult↗
PubMed1995

[The problem of lymph nodes in malignant epithelial tumors of the parotid gland].

Cervical lymph-node treatment in parotid gland epithelial malignancies is still debated. According to Literature, three different strategies (surgery, radiotherapy, "wait and see") have all been proposed theoretically, particularly when dealing with N0 cases. The present study was designed to evaluate the results of different lymphonode treatment strategies in 57 parotid gland carcinomas followed at the ENT Clinic of the University of Ferrara. The most frequent hystological patterns appeared to be the adenoidcystic carcinoma (33.3%) and the mucoepidermoid tumor (21.1%). Total parotidectomy was the treatment of choice in all cases. Ipsilateral neck dissection was performed in 14 cases (24.5%), 5 cases being N0. In 27 patients (47.4%) postsurgical radiotherapy was applied: in 7 cases on T and in 20 on both T and N.T recurrences were 7, while those of N and of both T and N were respectively 2 and 2. No occult metastases were found in N0 dissected patients. The results obtained led the Authors to the following conclusions: -neck dissection is fundamental in treatment of clinical adenopathies in any parotid gland malignancy: -postsurgical radiotherapy on the neck is the treatment of choice in all N0 carcinomas except in cases of acinic cell and mucoepidermoid carcinomas, where a "wait and see" policy seems to be more suitable.

Adolescent↗
PubMed1991

The influence of extent of neck treatment upon control of cervical lymphadenopathy in cancers of the oral tongue.

This is a retrospective analysis of the management of the neck in 84 patients with squamous cell carcinoma of the oral tongue treated with curative intent between 1968 and 1985. Patients with a clinically negative neck were treated to the neck only if the patient was thought to have a reasonable probability of occult neck metastases. This policy resulted in a 3-year adjusted neck control rate for N0 patients treated with limited (no, bilateral-partial, or ipsilateral) neck therapy of 38% compared with 95% for patients treated with bilateral, whole neck irradiation (p less than .001). None of the relapses in the patients with limited irradiation were in the treatment portal. Attempted salvage with a neck dissection resulted in cure in only 30%. The 3-year adjusted neck control rate for the N1 and N2 patients treated with total neck irradiation and surgery was 75% and 63%, respectively. The location of recurrence in these patients was in the field of irradiation, but contralateral to the side of the neck dissection.

Carcinoma, Squamous Cell↗
PubMed2005

Outcome of treatment for advanced cervical metastatic squamous cell carcinoma.

BACKGROUND: Patients with advanced cervical metastases from mucosal squamous cell carcinoma have a poor prognosis because of their high risk of regional and distal failure. This study aims to evaluate the outcomes of patients with clinical N2 or N3 disease managed with surgery and postoperative radiotherapy. METHODS: From a comprehensive computerized database, 181 entered patients who had neck dissection for N2 or N3 disease between 1988 and 1999 were evaluated. The mean age was 62 years, and minimum follow-up was 3 years. RESULTS: A total of 233 neck dissections were performed in 181 patients, including 163 comprehensive and 70 selective dissections. Postoperative radiotherapy was given in 82% of cases. The local control rate was 75% at 5 years, and control of disease in the treated neck was achieved in 86%. Macroscopic extracapsular spread (ECS) significantly increased regional recurrence (p = .001). Adjuvant radiotherapy significantly improved neck control (p = .004) but did not alter survival. Patients with ECS (both microscopic and macroscopic) who received radiotherapy had a significantly better survival than did patients with ECS who did not receive radiotherapy. Disease-specific survival for the entire group was 39% at 5 years. By use of multivariate analysis, macroscopic ECS and N2c neck disease were independent adverse prognostic factors for survival (p = .001). CONCLUSIONS: Despite a high rate of control in the treated neck, the poor survival (39%) in this patient group indicates that adjuvant therapeutic strategies need to be considered.

Adult↗
PubMed1985

Surgery for squamous cell carcinoma of the tongue and floor of the mouth.

Surgery for cancer of the tongue and floor of the mouth has become more varied and generally more conservative, influenced by advances in oncology and modern reconstructive methods. Combined therapy is favored, with postoperative irradiation and sometimes adjunctive chemotherapy, using cis-platinum. T1 carcinomas of the tongue and floor of the mouth can be treated with either wide local excision or irradiation alone, but surgery is the preferred method. T2-T4 tumors treated by resection combined with radiation therapy promise the best results. The indications and principles of the most important operative procedures are discussed: local excision; partial and total glossectomy; excision of the floor of the mouth with marginal mandibular resection; composite resection. Mandible sparing operations such as a modification of the "pull through" technique described by Stell or temporary splitting of the mandible are oncologically safe in many cases. A radical neck dissection is indicated in each carcinoma of the tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection appears justified in view of the high frequency of clinically occult lymph node metastases. Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining mobility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible. For immediate reconstruction, the most frequently used technique is the pectoralis major myocutaneous flap which has largely replaced the previously employed local and regional flaps. A significant problem remains with mandibular reconstruction.

Carcinoma, Squamous Cell↗
PubMed1998

[Effect of primary surgical therapy on the course of C-cell carcinoma of the thyroid gland].

The effect of the type of initial surgery for medullary thyroid carcinoma on the outcome is obscure. Some 40 patients with hereditary medullary thyroid carcinoma underwent either thyroidectomy and modified radical neck dissection (n = 18), subtotal thyroid resection (n = 10), or thyroidectomy (n = 12), partly with selective lymphadenectomy, as initial surgery. Patients who underwent thyroidectomy and modified radical neck dissection as their first operation had higher cure rates and lower morbidity. Thus the initial procedure is decisive for the further outcome in patients with hereditary medullary thyroid carcinoma.

Adolescent↗
PubMedDate not supplied

The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus.

The incidence of palpable and occult cancer and the absence of cancer in lymph nodes were determined for individual sites in the larynx and pharynx of 540 patients who underwent neck dissection. The incidence of palpable cancer in lymph nodes was lowest for cancers of the central supraglottis and transglottis (32-41%), intermediate for cancers of the marginal supraglottis and glossoepiglottis (48-57%), and highest for cancers of the pyriform sinus (69%). The incidence of occult cancer in lymph nodes for individual sites in the larynx and pharynx was determined by pathologic study of neck dissection specimens from 253 patients without palpable lymph nodes (NO neck). The incidence of occult lymphatic metastases in the NO neck and the need for elective neck irradiation were least for cancers of the transglottis and central supraglottis (14-16%), intermediate for cancers of the glossoepiglottis and the marginal supraglottis (20-38%), and greatest for cancers of the pyriform sinus (47%). The risk of nodal recurrence increased from 8% for those without cancer in lymph nodes to 38% for those with occult or palpable cancer in lymph nodes. A policy of observing the NO neck in patients with a low incidence of occult lymphatic metastases and a low risk of neck recurrence to avoid the unnecessary irradiation of many to benefit a few is discussed.

Humans↗
PubMed2003

[Characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on prognosis].

BACKGROUND & OBJECTIVE: Occult cervical lymph node metastasis in squamous cell carcinoma of tongue has regularity and influence on the prognosis of patients. This study was designed to investigate the characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis to provide clinical bases for elective supraomohyoid neck dissection. METHODS: The data of 164 patients with squamous cell carcinoma of tongue who were treated in cancer center, Sun Yat-sen University, from 1990 to 1996 were reviewed. The characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis were analyzed. RESULTS: The rate of occult cervical lymph node metastasis of squamous cell carcinoma of tongue was 25.71%. The most common site of occult cervical lymph node metastasis was ipsilateral level II, and followed by ipsilateral level I and III. 82.98% of the lymph nodes of occult metastasis occurred in the above three levels. Most cervical lymph nodes of occult metastasis were found within two years after the first operation (33/36). There was significant difference of the prognosis between the group of dominant or occult cervical lymph node metastasis and the group of without cervical lymph node metastasis in squamous cell carcinoma of tongue (log-rank,P< 0.01); whereas there was no significant difference of the prognosis between the group of dominant cervical lymph node metastasis and the group of occult cervical lymph node metastasis according to log-rank test (P >0.05). CONCLUSION: The ipsilateral level I to level III were the common regions where occult cervical lymph node metastasis occurred. The authors suggest that elective supraomohyoid neck dissection may be applied to clinically negative neck of the patients with squamous cell carcinoma of tongue who were prone to metastasize latently. Occult cervical lymph node metastasis influences the prognosis of patients with squamous cell carcinoma of tongue significantly.

Adult↗
PubMed1992

[Acute side effect of postoperative radiotherapy in malignant head and neck neoplasm]

From August 1989 to May 1991,160 patients with malignancies of the head and neck region were treated by surgery and postoperative radiotherapy.Seventy seven patiens underwent resection of the primary lesion combined with neck dissection and 83 patients had resecton of the primary lesion only before radiotherapy.After irradiation 33.8% (54/160) patients developed edema in face and neck,13.1%(21/160) patients developed headache.The style of neck dissection (unilateral,bilateral or no neck dessection) did significantly influence the rates of the acute side effect(P<0.01).The interval between surgery and radiotherapy and radiation dose were not important influential factors(P>0.05).The clinical manifestations,possible mechanism and prevention of the acuter side effect is presented.

Journal Article↗
PubMed1989

[A study of a regional lymph node metastasis in a well-differentiated thyroid carcinoma].

Forty-eight patients with a well-differentiated thyroid cancer that occupied unilateral lobe were given, a modified radical neck dissection (unilateral or bilateral). After an examination of their lymph nodes, a retrospective analysis showed that the metastasis extended to the lateral cervical lymph node on the ipsilateral neck in 43.8% of all cases, and to at least the paratracheal lymph node on the contralateral neck in 27.2% of all cases. Therefore a bilateral modified radical neck dissection is needed surgical treatment for such patients.

Adenocarcinoma↗
PubMed2004

Management of stage IV glottic carcinoma: therapeutic outcomes.

OBJECTIVES/HYPOTHESIS: The best therapeutic approach for the treatment of stage IV glottic carcinoma is controversial. STUDY DESIGN: A retrospective study. METHODS: A retrospective study of Tumor Research Project data was performed using patients with stage IV glottic squamous cell carcinoma treated with curative intent by five different treatment modalities from 1955 to 1998 at Washington University School of Medicine and Barnes-Jewish Hospital (St. Louis, MO). RESULTS: Ninety-six patients with stage IV glottic carcinoma were treated by five modalities: total laryngectomy (TL) (n = 13), total laryngectomy with neck dissection (TL/ND) (n = 18), radiation therapy alone (RT) (n = 7) (median dose, 69.5 Gy), total laryngectomy combined with radiation therapy (TL/RT) (n = 10), and total laryngectomy and neck dissection combined with radiation therapy (TL/ND/RT) (n = 48). The overall 5-year observed survival (OS) rate was 39%, and the 5-year disease-specific survival (DSS) rate was 45%. The 5-year DSS rates for the individual treatment modalities included the following: TL, 58.3%; TL/ND, 42.9%; RT, 50.0%; TL/RT, 30.0%; and TL/ND/RT, 43.9%. There was no significant difference in DSS for any individual treatment modality (P =.759). The overall locoregional control rate was 69% (66 of 96). The overall recurrence rate was 39% with recurrence at the primary site and in the neck at 19% and 17%, respectively. Recurrence was not related to treatment modality. The 5-year DSS after treatment of locally recurrent cancer (salvage rate) was 30% (3 of 10) and for recurrent neck disease (28 of 67) was 42%. The incidence of delayed regional metastases was 28%; of distant metastasis, 12%; and of second primary cancers, 9%. There was no statistically significant difference in survival between node-negative (N0) necks initially treated (5-y DSS, 31%) versus N0 necks observed and later treated if necessary (5-y DSS, 44%) (P =.685). CONCLUSION: The five treatment modalities had statistically similar survival, recurrence, and complication rates. The overall 5-year DSS for patients with stage IV glottic carcinoma was 45%, and the OS was 39%. The cumulative disease-specific survival (CDSS) was 0.4770 with a mean survival of 10.1 years and a median survival of 3.9 years. Patients younger than age 55 years had better survival (DSS) than patients 56 years of age or older (P =.0002). Patients with early T stage had better survival than patients with more advanced T stage (P =.04). Tumor recurrence at the primary site (P =.0001) and in the neck (P =.014) and distant metastasis (P =.0001) had a deleterious effect on survival. Tumor recurrence was not related to treatment modality. Patients with clear margins of resection had a statistically significant improved survival (DSS and CDSS) compared with patients with close or involved margins (P =.0001). Post-treatment quality of life was not significantly related to treatment modality. Patients whose N0 neck was treated with observation and appropriate treatment for subsequent neck disease had statistically similar survival compared with patients whose N0 neck was treated prophylactically at the time of treatment of the primary. A minimum of 7 years of follow-up is recommended for early identification of recurrent disease, second primary tumors, and distant metastasis. None of the standard treatment modalities currently employed has a statistical advantage regarding survival, recurrence, complications, or quality of life.

Adult↗
PubMed2002

Incidental metastatic papillary thyroid carcinoma in microvascular reconstruction.

OBJECTIVES/HYPOTHESIS: Occult papillary thyroid carcinoma has a reported prevalence of 1% to 35% based on autopsy studies. Cervical lymphatic metastases from papillary thyroid carcinoma have been associated with a higher likelihood of recurrence with a questionable impact on survival. Without clinically evident disease in the thyroid or cervical nodes, management of these patients presents a treatment dilemma. We propose an individualized treatment plan for patients in whom metastatic papillary thyroid carcinoma is incidentally detected during neck exploration for other purposes. STUDY DESIGN: Retrospective review and discussion of the literature. METHODS: The clinical course of two patients with incidentally discovered metastatic papillary thyroid carcinoma to the cervical lymph nodes is described. Both patients had previously received head and neck irradiation in childhood and required free flap reconstruction of extensive skull base defects following extirpation of meningiomas. RESULTS: Neck dissection specimens from levels I and II obtained during exposure of recipient vessels for microvascular tissue transfer revealed papillary thyroid carcinoma in both cases. The patients subsequently underwent total thyroidectomy, neck dissection, and postoperative radioactive iodine ablation of residual thyroid tissue. After 1 year of follow-up, both patients were without evidence of recurrent disease. CONCLUSIONS: An individualized approach is justified to treat metastatic papillary thyroid carcinoma incidentally discovered during other procedures. The case reports underscore the importance of pathological analysis of surgical specimens obtained during head and neck reconstruction.

Adult↗
PubMedDate not supplied

[Retrospective analysis of results of treatment of 91 oral cavity cancers from 1982 to 1992].

PURPOSE: To analyse retrospectively the results of different treatment regimens of carcinomas of the floor of the mouth and tongue. MATERIALS AND METHODS: Between 1982 and 1992, 61 patients with carcinoma of the floor of the mouth and 30 with tongue cancer (25 stage I, nine stage II, 28 stage III, 29 stage IV) were treated in the radiotherapy department of Poitiers. Nine patients with stage I tumours were treated with 70 Gy low-dose rate brachytherapy only, without nodal dissection. Stages II and III were treated with combined surgery with neck dissection; and radiotherapy of stage II with nodal metastasis and for all stage III cases. Stage IV cases were treated either surgically if possible, or with combined chemotherapy and radiation. RESULTS: The five-year overall survival rate was 87.3% for stage I, 68.5% for stage II, 45.3% for stage III, and 0% for stage IV patients. Most relapses appeared in the first two years after treatment. Eight patients (32%) with stage I cancer developed nodal relapses, isolated in five cases. Complications of radiotherapy were acceptable. Four cases of osteonecrosis were observed after radiotherapy. All of these appeared simultaneously with a local relapse. CONCLUSION: These results are comparable with reports in the literature. The remarkable observation of our study is the high incidence of nodal recurrences after local treatment of stage I tumours. Therefore, local treatment is insufficient for early-stage tumours. The question of neck dissection for the early stage is discussed.

Adult↗
PubMed1977

Management of carcinoma of the thyroid.

Greater precision has developed in recent decades in the selection of patients for operation for thyroid nodules suspicious for malignancy and in adapting operative procedures to the extent and pathologic variety of the individual thyroid carcinoma, when present. A thyroid lobectomy is considered to be the minimal operative procedure usually indicated for a suspicious thyroid nodule or carcinoma involving one lobe of the thyroid gland. Factors determining the extent of operation for thyroid carcinoma include the pathologic variety, gross distribution of the malignancy, and health status of the individual patient. Total or near total thyroidectomy should be considered for all patients with thyroid carcinoma except for single occult carcinomas and unilateral low grade angio-invasive carcinomas. Removal of lymph nodes in regions adjacent to the thyroid carcinoma is advisable, lateral neck dissections being reserved for patients with palpable lymphadenopathy, demonstrated metastases to lateral cervical lymph nodes, or a poorly differentiated carcinoma likely to metastasize to these lymph nodes. A modified radical lymph node dissection is satisfactory except for those carcinomas invading muscles in the neck. Anatomic neck dissections provide a better prognosis than incomplete lymph node procedures for patients with regional lymph node metastases. Following operation, patients should receive thyroid hormone therapy, be evaluated for possible treatment with radioactive iodine or other therapeutic measures, and be followed for evidence of recurrent disease as well as thyroid and parathyroid function. Adequate early operation is preferred to late ultraradical procedures, from standpoints of morbidity and prognosis. Unfavorable prognostic factors include extensive gross disease, poorly differentiated carcinoma present as the entire lesion or as foci in a differentiated carcinoma, and age over 40. With adequate surgical treatment, the prognosis for operable thyroid carcinoma is good.

Carcinoma↗
PubMed2005

[Pathological feature and management of occult lymphatic metastasis in supraglottic carcinoma].

OBJECTIVE: To study the pathologic feature and management methods of occult lymphatic metastasis in patients with supraglottic carcinoma. METHODS: The following are criteria of patients selection: (1) Supraglottic squamous cell carcinoma; (2) Clinical N0M0; (3) no preoperative radiotherapy and (or) chemotherapy. Thirty patients were recruited, male 19 cases, female 11; age: 40 - 72yr, average 54.8yr; T2 8 cases, T3 18, T4 4 (by UICC 1997). Ipsilateral supraomohyoid neck dissections were performed in all cases. Lymph nodes were studied histologically according to the levels of dissection. RESULTS: Six of 30 cases were positive nodes histologically in first operation, 3 were occurrence neck metastasis in opposite side during follow ups. Occult metastasis rate was 20% (6/30) ipsilaterdly and 10% contralaterally. 527 lymph nodes were collected in all of 30 patients, average 17.6 nodes in every side neck. Ten positive lymph nodes histologically were harvested. The distribution of metastatic lymph nodes was 9 in level II, 1 in level III, no in level I. N0 recurrence in larynx and (or) at the neck after dissection. Two years survival rates was 86.7% (26/30) without tumor. CONCLUSION: Occult metastasis rate of supraglottic carcinoma is as high as 30%. The selective lateral neck dissection of level II, III and occasionally, level IV was recommended.

Adult↗
PubMed2006

Concurrent chemoradiotherapy for locally advanced, nonmetastatic, squamous carcinoma of the head and neck: consensus, controversy, and conundrum.

Radiotherapy and concurrent chemotherapy (CRT) is superior to radiotherapy alone for the treatment of locally advanced, nonmetastatic squamous carcinoma of the head and neck (HNC). Three issues affect the use of CRT as primary treatment for advanced HNC. The first issue is the definition of advanced stage and the initial therapeutic choice of surgery or CRT and the role of post-CRT neck dissection. Function preservation considerations should guide the choice between surgery and CRT for patients with resectable disease. Fluorodeoxyglucose-positron emission tomography scanning may identify patients who require adjuvant neck dissection. The second issue is optimization of radiotherapy and chemotherapy schedules. Ideally, concurrent chemotherapy should be incorporated into radiotherapy (RT) regimens that would constitute optimal therapy were RT to be administered as single-modality treatment. Modified fractionation schemes constitute optimal single-modality RT. Platinum schedules other than bolus dosing every 3 to 4 weeks are effective and may be less toxic. The third issue is integration of biologically targeted therapy into CRT treatment programs. Epidermal growth factor receptor blockade enhances the effectiveness of RT alone. Its role and that of angiogenic blockade in CRT are under investigation.

Antibodies, Monoclonal↗
PubMedDate not supplied

Results of curative laser microsurgery of laryngeal carcinomas.

INTRODUCTION: Between 1979 and 1991 the author treated more than 1,200 patients with malignant tumors of the upper-aerodigestive tract transorally using laser microsurgery with curative, palliative, or symptomatic intention. PATIENTS AND METHODS: This report is based on 240 patients without prior treatment, treated between 1979 and 1985 with curative intention for cancer of larynx (pTis-pT4 (p)N0-pN2c). Patients with simultaneous second primaries and/or distant metastases were excluded. Neck metastases of the category N3 (UICC 1987) were not found in the group. Patients were divided into two groups. Group A (n = 159) includes glottic cancer as follows: Tis, 29; T1, 96; T2 (small, vocal cord mobile), 34. All patients were treated by laser microsurgery. There were only 6% local recurrences with one patient needing total laryngectomy. The overall 5-year survival rate (Kaplan-Meier) was 86.5%. The adjusted 5-year survival rate was 100%. The group B patients (n = 81) included 30 supraglottic patients. Fifty-eight patients were in tumor category pT2, among them there were 38 with glottic cancer (so called T2b, with vocal cord mobility impaired). Seventeen patients had pT3 and 6 pT4 tumors. RESULTS: Treatment consisted of laser microsurgery plus/minus neck dissection (23/81 = 28%) (mainly regionally limited functional surgery, only four radical neck dissections) plus/minus postoperative radiotherapy (29/81 = 35%). There were 22% local recurrences with six patients requiring total laryngectomy. The overall 5-year survival rate (Kaplan-Meier) was 59%. DISCUSSION: This study confirms the usefulness of laser microsurgery for laryngeal carcinoma. Surgery is individualized and adapted to the size of the tumor. Multiinstitutional studies are needed to compare laser microsurgery with radiation therapy.

Adult↗
PubMed1996

Major glossectomy: end results of 106 cases.

Advanced cancers of the oral cavity continue to be a therapeutic challenge. Despite significant improvements in radiotherapeutic techniques and adjuvant chemotherapy, patients usually die after a short period. Recent progress in reconstructive techniques has made major glossectomy (subtotal, near total, total or extended total) a reasonable palliative and potentially curative approach. It is the purpose of this study to report a series of 106 patients treated from 1985 to 1994 regarding surgical complications and prognosis. All but 1 patient undergoing major glossectomy had squamous cell carcinoma. Primary tumour sites were oral tongue (50 cases), base of the tongue (18 cases), floor of the mouth (28 cases) and other parts of the mouth (10 cases). Tumour stages were: 25 T3, 57 T4, 24 Tx, 34 N0, 20 N1, 32 N2a-N3, 20 Nx. The types of glossectomy were as follows: 24 subtotal, 31 near total and 51 total. A total laryngectomy was performed in only 6 cases. A neck dissection was performed in all but 3 patients: 12 unilateral radical neck dissection (RND), 1 unilateral supra, omohyoid (SOH), 39 simultaneous bilateral RND, 8 simultaneous bilateral SOH, and 43 RND associated to contralateral SOH. A pectoralis major myocutaneous flap was used to repair the operative defect in 96 cases. Complications were seen in 52 cases (49%). The most common complications were wound infection (17 cases), flap necrosis (15 cases) and fistula (15 cases). Significant transient aspiration was seen in 8 patients. At the study closing date, 30 patients were alive without disease, 5 had recurrent disease, 47 died of cancer, 14 died of causes not related to cancer or treatment and 10 were lost to follow-up. The 5-year actuarial survival rates were, respectively, 45%, 18% and 18% for T3, T4 and Tx. Other significant variables were pN stage (P = 0.0672) and year of admission (0.0318). In conclusion a major glossectomy without laryngectomy whenever possible is a safe procedure for a selected group of patients with advanced tongue and floor of the mouth cancer. The actuarial survival rates presented suggests that, in a very select group of patients, major glossectomy is a surgical procedure to be considered.

Aged↗