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Prognosis of oral cavity carcinomas operated either primarily or secondarily by mandibulectomy and free fibular flap reconstruction

par Jortay, Albert ;Bisschop, Pierre ;Pelc, Patricia ;Coessens, Bruno
Référence Acta oto-rhino-laryngologica Belgica, 53, 4, page (336)
Publication Publié, 1999

Article révisé par les pairs

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Résumé :

Introduction : two different conditions may be encountered : advanced lesions requiring primary radical surgery including mandibulectomy and flap reconstruction and carcinomas relapsing after limited surgery and postoperative XRT secondarily treated by salvage surgery. We present our experience in the management of these potentially aggressive oral cavity tumors. Material : 14 oral cavity carcinomas comprizing 8 patients with advanced disease (6T4, 1T3, 1T2N3) who have been treated with mandibulectomy and fibular free flap reconstruction and 6 other patients with recurring carcinomas (2T1, 2T2, 2T4) after XRT or combined surgery with XRT (50-70Gy) who had a radical salvage procedure including mandibulectomy and fibular free flap. Results : oncologic results : among the 8 patients primarily operated, 7 patients are evaluable (1 p.o. death) 5 survived NED on periods from 1 to 5 years. One patient died from local recurrence (6 months) and another one from intercurrent disease (2 years). For the group of 6 patients secondarily operated, no one survived, 5 died from local recurrence (3 to 22 months) and one from intercurrent disease (6 months). Conclusion : we should reconsider our surgical strategy specially for limited T1T2 lesions quite close to the mandibule and recommend a commando procedure including a segmental resection of the mandible and a radical neck dissection. Postoperative XRT should be proposed for not free margins and multiple involved neck nodes.