ABSTRACT
BACKGROUND: Appropriate selection of tongue cancer patients considering surgery is critical in ensuring optimal outcomes. The American College of Surgeons' National Surgical Quality Improvement Program ('ACS-NSQIP') risk calculator was developed to assess patients' 30-day post-operative risk, providing surgeons with information to guide decision making. METHOD: A retrospective review of 30-day actual mortality and morbidity of tongue cancer patients was undertaken to investigate the validity of this tool for South Australian patients treated from 2005 to 2015. RESULTS: One hundred and twenty patients had undergone glossectomy. Predicted length of stay using the risk calculator was significantly different from actual length of stay. Predicted mortality and other complications were found to be similar to actual outcomes. CONCLUSION: The American College of Surgeons' National Surgical Quality Improvement Program risk calculator was found to be effective in predicting post-operative complication rates in South Australian tongue cancer patients. However, significant discrepancies in predicted and actual length of stay may limit its use in this population.
Subject(s)
General Surgery , Glossectomy , Length of Stay , Patient Selection , Quality Improvement , Surgical Flaps , Tongue Neoplasms/surgery , Aged , Female , Glossectomy/mortality , Humans , Male , Middle Aged , Plastic Surgery Procedures , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk Factors , Societies, Medical , South Australia , Tongue Neoplasms/diagnosis , Tongue Neoplasms/mortality , Treatment Outcome , United StatesABSTRACT
BACKGROUND: Few studies on tongue reconstruction provide a comprehensive, multidisciplinary analysis examining defect size, flap selection, function, and long-term survival. This report presents the largest study in the literature evaluating free flap reconstruction after glossectomy. METHODS: A retrospective review of patients undergoing free flap glossectomy reconstruction from 2000 to 2012 was performed. RESULTS: In this review, 268 patients were identified. Resections involving the tongue only included 59 partial glossectomies, 86 hemiglossectomies, 28 subtotal glossectomies, and 24 total glossectomies. Glossectomies performed with mandibulectomies were analyzed independently for speech and swallowing function (32 partial glossectomies, 18 hemiglossectomies, 8 subtotal glossectomies, and 13 total glossectomies with mandibulectomy). A total of 299 free flaps were performed, with 30 patients receiving two free flaps. Multivariate analysis demonstrating smoking (p = 0.018), composite resections (p < 0.001), and larger resections (total and subtotal glossectomies; p < 0.001) were associated with significantly worse speech results. Advanced age (p = 0.002), radiation (p = 0.003), and larger or composite resections had significantly worse swallowing function (p < 0.001). Patients with a persistent tracheostomy had significantly worse speech and swallowing function (p < 0.001), whereas innervated flaps were associated with superior speech (p = 0.049) and better swallowing function (p = 0.004). The surgical complication rate was 23.5 %, with only one total flap loss. Tumor stage (p = 0.003), positive margins (p < 0.001), lymphovascular invasion (p = 0.023), and chemotherapy (p < 0.001) were associated with significantly worse overall survival. The median overall survival time was 50.5 months (range 39-79 months). CONCLUSIONS: Although comorbidities and the extent of resection impair both speech and swallowing, reconstruction, particularly with innervated free flaps, still affords the majority of patients' reasonable function.
Subject(s)
Free Tissue Flaps/blood supply , Glossectomy/mortality , Microvessels/surgery , Neoplasm Recurrence, Local/mortality , Plastic Surgery Procedures/mortality , Tongue Neoplasms/mortality , Vascular Surgical Procedures/mortality , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Deglutition , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Postoperative Complications , Prognosis , Retrospective Studies , Survival Rate , Tongue Neoplasms/pathology , Tongue Neoplasms/surgery , Young AdultABSTRACT
The purpose of this study was to assess prognostic factors, treatment outcomes and patterns of relapse in patients with early stage (T1-2 N0) squamous cell carcinoma of oral tongue treated primarily by surgery. The medical records of all patients with early stage (T1-2 N0) oral tongue cancer, radically treated at King Faisal Specialist Hospital and Research Center between January 1980 and December 1997, were reviewed. Eighty-five patients were identified for analysis, 38 male and 47 female. With a median follow-up for surviving patients of 64 months, 5-year actuarial overall, disease-specific (DSS), and relapse-free survival (RFS) were 71, 75, and 63%, respectively. Univariate analysis for DSS showed survival advantage for patients with tumor thickness (TT) of < or =10 mm (P=0.0002) and distance from resection margin (DFRM) of > 5 mm (P=0.005). The effect of TT of < or =10 mm was maintained (P=0.001) on multivariate analysis. Higher RFS was observed with TT of < or =10 mm (P=0.0002), DFRM of > 5 mm (P=0.0002) and DFRM of >10 mm (P=0.007). On multivariate analysis higher RFS was also found for TT < or =10 mm (P=0.01) and DFRM >5 mm (P=0.01). Salvage of local tongue recurrence was higher than neck node failure, with 5-year DSS of 71 and 19%, respectively (P=0.007). Time interval for recurrence showed no significant impact on outcome. In T1-2 N0 oral tongue cancer, TT, and DFRM are significant prognostic factors for both local control and survival. Neck node recurrence is associated with poor prognosis and low salvage rate.
Subject(s)
Carcinoma, Squamous Cell/surgery , Tongue Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/radiotherapy , Cohort Studies , Combined Modality Therapy , Data Interpretation, Statistical , Disease-Free Survival , Female , Glossectomy/methods , Glossectomy/mortality , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Neoplasm Recurrence, Local/mortality , Prognosis , Saudi Arabia/epidemiology , Smoking/adverse effects , Smoking/mortality , Survival Rate , Tobacco, Smokeless/adverse effects , Tongue Neoplasms/mortality , Tongue Neoplasms/radiotherapyABSTRACT
Se analizó la evolución a largo plazo de 135 enfermos portadores de cáncer epidermoide de lengua Estadios III y IV. La llegada tardía a la consulta ha significado que sólo el 21.7% pudiera ser pasible de tratamiento. Predominó el Estadio IV en casi 2/3 de la población y el sexo masculino en una relación 4.86:1. La mayor incidencia se registró en la 6a y 7a década de la vida y juntas representaron más del 50%. La supervivencia global fue del 9.5% a 5 años, observándose que los únicos factores que incidieron en forma estadísticamente significativa fueron el tamaño del primario, la presencia de adenopatías metastásicas y el grado de diferenciación celular. En cambio el sexo, la edad y la topografía no alcanzaron significación pronóstica. Los mejores resultados terapéuticos se obtuvieron con cirugía, complementada con telecobaltoterapia en Estadio III. La quimioterapia neoadyuvante no contribuyó a mejorar la supervivencia ni prolongar los períodos libres de enfermedad. La gran proporción de lesiones avanzadas conduce a divulgar los factores de riesgo a nivel popular y producir una mayor información en el pregrado universitario
Subject(s)
Comparative Study , Humans , Male , Female , Adult , Middle Aged , Aged , Tongue Neoplasms/mortality , Carcinoma, Squamous Cell/epidemiology , Tongue Neoplasms/drug therapy , Tongue Neoplasms/radiotherapy , Carcinoma, Squamous Cell/therapy , Glossectomy/statistics & numerical data , Glossectomy/mortality , Radioisotope Teletherapy/statistics & numerical data , Radiotherapy/statistics & numerical data , Drug Therapy/adverse effects , Drug Therapy/statistics & numerical data , Survival Rate , Cell Transformation, NeoplasticABSTRACT
Se analizó la evolución a largo plazo de 135 enfermos portadores de cáncer epidermoide de lengua Estadios III y IV. La llegada tardía a la consulta ha significado que sólo el 21.7% pudiera ser pasible de tratamiento. Predominó el Estadio IV en casi 2/3 de la población y el sexo masculino en una relación 4.86:1. La mayor incidencia se registró en la 6a y 7a década de la vida y juntas representaron más del 50%. La supervivencia global fue del 9.5% a 5 años, observándose que los únicos factores que incidieron en forma estadísticamente significativa fueron el tamaño del primario, la presencia de adenopatías metastásicas y el grado de diferenciación celular. En cambio el sexo, la edad y la topografía no alcanzaron significación pronóstica. Los mejores resultados terapéuticos se obtuvieron con cirugía, complementada con telecobaltoterapia en Estadio III. La quimioterapia neoadyuvante no contribuyó a mejorar la supervivencia ni prolongar los períodos libres de enfermedad. La gran proporción de lesiones avanzadas conduce a divulgar los factores de riesgo a nivel popular y producir una mayor información en el pregrado universitario
