Surgical Management of Oral Squamous Cell Carcinoma
Surgery remains one of the principal treatment modalities of oral squamous cell carcinoma. With improved understanding of biologic behavior, pattern of spread of tumors of different subsites, and instrumentation, several technical modifications have been
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Surgical Management of Oral Squamous Cell Carcinoma Moni Abraham Kuriakose and Nirav P. Trivedi
6.1
Introduction
Surgery remains one of the principal treatment modalities of oral squamous cell carcinoma. With improved understanding of biologic behavior, pattern of spread of tumors of different subsites, and instrumentation, several technical modifications have been adopted in the recent past to improve oncological, functional, and aesthetic outcome of ablative surgery for oral cancer. Oral cavity consists of various subsites that include lip, alveolus, buccal mucosa, tongue, floor of mouth, and hard palate. Each of these subsites has unique anatomic features that determine the pattern of invasion of tumor and biologic behavior. In addition, each of these subunits plays varying vital functions such as speech, mastication, and swallowing. Ablative surgery of these subsites would result in different degree of functional and cosmetic morbidity with significant impact in quality of life of patients. It is essential to select the appropriate surgical approaches and extent of resection that offers the best oncologic and functional outcome. For early stage (T1) oral cavity cancers, though both surgery and radiation therapy offered similar oncologic outcome, morbidity associated with radiation of oral cavity prevented its wider use. It is observed that functional outcome is poorer with
M.A. Kuriakose, MD, FRCS (*) Department of Head and Neck, Plastic and Reconstructive Surgery and Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA Department of Head and Neck Surgery, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya Health City, Bangalore, India e-mail: [email protected] N.P. Trivedi, MS, MCh Department of Head and Neck Surgery, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya Health City, Bangalore, India Department of Head and Neck Surgery, Narayana Health City, Ahammedabad, India © Springer International Publishing Switzerland 2017 M.A. Kuriakose (ed.), Contemporary Oral Oncology, DOI 10.1007/978-3-319-14917-2_6
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primary radiotherapy compared to primary surgery due to associated xerostomia, mucositis, long-term food intolerance, “radiation-caries” affecting teeth and risk of osteoradionecrosis. In comparison, primary surgery is better tolerated, faster, and less morbid. For advanced cancers that require multimodality treatment, surgery followed by radiotherapy or chemoradiotherapy (CT-RT) has been the standard of care for many years and continues to be so.
6.2
Principles of Ablative Surgery
The goal of ablative surgery is to remove tumor with microscopically uninvolved margin with least aesthetic and functional impairments. Balancing these two contradicting objectives require precise understanding of the subsite anatomy and function, pattern of invasion of tumor, and tumor biology. To meet these goals, oncologic surgical principles pertaining to the oral cavity needs to be followed. These include: 1 . Adequacy of surgical margins 2. Appropriate u
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