Surgical resection of oral cancer: en-bloc versus discontinuous approach
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HEAD AND NECK
Surgical resection of oral cancer: en‑bloc versus discontinuous approach Giancarlo Tirelli1 · Alice Piccinato1 · Paolo Antonucci1 · Annalisa Gatto1 · Alberto Vito Marcuzzo1 · Margherita Tofanelli1 Received: 7 January 2020 / Accepted: 26 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives In the past literature agreed on treating oral carcinomas, using an “en-bloc” resection (EBR) but recently minimally invasive transoral surgery has spread as the preferable treatment for selected cases. This latter technique, which is performed with a discontinuous resection (DR), allows for a satisfactory postoperative quality of life (QoL) maintaining good survival rates. Materials and methods In this study, we analyzed data about 147 surgically treated patients with oral cancer involving tongue and floor of the mouth. The sample was divided according to the surgical approach: EBR and DR group which were compared in terms of recurrence, overall survival, disease-free survival, and QoL. Results In the DR group, survival analysis showed better results in term of survival, locoregional control, and postoperative anxiety, while the other QoL scores were similar in the two groups. Conclusion The more invasive approach does not correlate to a better outcome. In selected cases, DR is an oncologically safe technique; EBR is still a valid option to treat advanced oral cancers Keywords T–N tract · Oral cancer · Neck dissection · Transoral surgery · Compartmental surgery
Introduction Oral cavity represents the main localization of onset of head-and-neck cancer, particularly squamous cell carcinomas, with a worldwide estimated incidence of 275,000 new cases every year [1, 2]. Oral squamous cell carcinomas (OSCC) are characterized by a poor prognosis and a low overall survival (OS) with a 5-year survival rate in most developed countries around 50% [2]. Surgery has long been the most well-established and accepted approach for the treatment of most OSCC; however, despite sophisticated treatment modalities, the survival of patients with OSCC has not largely improved over last decades [3]. The unchanging poor prognosis of oral cancer raises the doubt that some decision-making processes may be incomplete and should be changed to improve survival rates. * Alberto Vito Marcuzzo [email protected] 1
Head and Neck Department, ENT Clinic, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
The factors that mainly impact to the prognosis are the tumor diameter and thickness, positive or close margins, and perineural-lymphovascular invasion [4–6]. In our experience, the factors that significantly influenced survival in patients surgically treated for oral cancer were the surgical approach, the neck stage, and the depth of invasion (DOI) [7]. A recent study investigating the surgical treatment of tongue cancer reported that patients who underwent compartmental surgery, which necessarily includes an en-bloc approach with tumor, cervical lymph nodes, a
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