Yıl 2021, Cilt 11 , Sayı 1, Sayfalar 12 - 17 2021-01-30

PROBLEMS RELATED TO SURGERY AND PATHOLOGY IN LIP CANCER PATIENTS AND THEIR MANAGEMENT
DUDAK KANSERİ HASTALARINDA CERRAHİ VE PATOLOJİYE İLİŞKİN SORUNLAR VE YÖNETİMİ

Tuğba GÜN KOPLAY [1] , Mehtap ŞEN [2]


Purpose: Lip cancers are the second most common cancers of head and neck region. Due to its functional and aesthetic consequences and aggressive course, clinical approach including surgical margins, type of neck dissection and reconstruction techniques are debated topics in lip cancer. We investigated reliability of preoperative evaluations, pathological risk factors for recurrence or metastasis, surgery related morbidities and their management. Methods: The records of patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were reviewed retrospectively. Demographic data of the patients were evaluated, the reliability of the punch biopsy and radiological imaging was discussed and the effects of pathological features on the risk of recurrence and metastasis was investigated. Surgery related morbidities were revealed. All these problems and their solutions were discussed in the light of literature. Results: Punch biopsy was found unreliable in this study. Relapses were associated with advanced stage and perineural invasion while cervical metastasis was related with the size of the specimen and surgical margins. Donor site morbidities were higher in local flaps. Recurrence or metastases were not observed in patients who were treated with extensive excision, neck dissection and reconstruction with free flap. Conclusions: Early diagnosis and functional and aesthetic repair are the most important factors in terms of prognosis in lip cancer. First surgery is very important that determines the prognosis. As the stage progresses, the surgery becomes complex but prognosis can be as good as early stages with good clinical approach.
Giriş: Dudak kanserleri baş boyun bölgesinde ikinci sıklıkta görülen kanserlerdir. Fonksiyonel ve estetik sonuçları ve agresif seyri sebebiyle cerrahi eksizyon sınırları, boyun diseksiyonu tipi ve rekonstrüksiyon seçenekleri gibi klinik yaklaşım tipleri dudak kanseri hakkında tartışılan konulardır. Çalışmada cerrahi öncesi yapılan değerlendirmelerin güvenilirliği, rekürrens ve metastaz için risk faktörleri, cerrahiye bağlı morbiditeler ve tedavileri araştırıldı. Method: Kliniğimizde tedavi edilen bazal hücreli karsinom ve squamoz hücreli karsinom tanılı hastaların verileri retrospektif olarak tarandı. Hastaların demografik verileri değerlendirildi, punch biyopsi ve radyolojik görüntülemelerin güvenilirliği tartışıldı ve patolojik özelliklerin rekürrens ve metastaz risk üzerine etkileri araştırıldı. Cerrahi sonrası morbiditeler değerlendirilerek tüm bu problemler ve çözüm yolları literatür eşliğide tartışıldı. Sonuç: Bu çalışmada punch biyopsi güvenilir bulunmadı. Rekürrensler ileri evre ve perinöral invazyon ile, servikal metastazlar ise çıkartılan lezyon boyutu ve cerrahi sınır ile ilişkili bulundu. Lokal fleplerde donor alan morbiditeleri daha yüksekti. Geniş eksizyon, boyun diseksiyonu ve serbest flep ile rekonstrüksiyon yapılan hasta grubunda rekürrens veya metastaz gözlenmedi. Tartışma: Erken tanı ve fonksiyonel-estetik onarım dudak kanseri prognozunda en önemli faktörlerdir. Yapılan ilk cerrahi prognozu belirlediğinden çok önemlidir. Evre ilerledikçe cerrahi kompleksleşir fakat iyi bir klinik yaklaşım ile erken evreler kadar iyi bir prognoz sağlanabilir.
  • REFERENCES 1. Zhao R, Jia T, Qiao B, at al. Nomogram predicting long-term overall survival and cancer-specific survival of lip carcinoma patients based on the SEER database. Medicine 2019; 98:e16727.
  • 2. Singer S , Zeissig SR , Emrich K, Holleczek B, Kraywinkel K, Ressing M. Incidence of lip malignancies in Germany: Data from nine population-based cancer registries. J Oral Pathol Med 2017; 46:780-85.
  • 3. Kristensen RN, Andersen PS, Andersen JL. Lip carcinoma: clinical presentation, surgical treatment, and outcome: a series of 108 cases from Denmark, Journal of Plastic Surgery and Hand Surgery 2017;51:342-47.
  • 4. Ho T, Byrne PJ. Evaluation and initial management of the patient with facial skin cancer. Facial Plast Surg Clin North Am 2009;17:301-307.
  • 5. Bilkay U.,Kerem H., Ozek C, et al. Management of Lower Lip Cancer: A Retrospective Analysis of 118 Patients and Review of the Literature. Ann. Plast. Surg. 2003; 50:43-50.
  • 6. Babington S, Veness MJ, Cakir B et al. Squamous cell carcinoma of the lip: is there a role for adjuvan radiotherapy in improving local control following incomplete or inadequate excision? ANZ J Surg 2003; 73: 621-25.
  • 7. Wermker K, Belok F, Schipmann S , Klein M , Schulze HJ, Hallermann C. Prediction model for lymph node metastasis and recommendations for elective neck dissection in lip cancer. Journal of Cranio-Maxillo-Facial Surgery 2015; 1-8.
  • 8. Keravala C, T Roques T, Jeannon P, Bisase B. Oral cavity and lip cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2016; 130: 83-9.
  • 9. Hokkam E, Gomaa A, Rifaat M, Alharbi F, Gonna A, Fathi H, Faisal M. The Role of sentinel lymph-node biopsy in managing lip squamous cell carcinoma patients without clinical evidence of nodal metastasis. Gulf J Oncolog 2013;1:57-62.
  • 10. Olgun Y, Durmusoğlu M, Dogan E, Erdag TK, Sarıoglu S, İkiz AO. Role of Elective Neck Dissection in Early Stage Lip Cancers. Turk Arch Otorhinolaryngol 2015; 53: 23-25.
  • 11. Bota JP, Lyons AB, MD, Carroll BT. Squamous Cell Carcinoma of the Lip: A Review of Squamous Cell Carcinogenesis of the Mucosal and Cutaneous Junction. Dermatol Surg 2017;43:494–506.
  • 12. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471–74.
  • 13. Vukadinovic M, Jezdic Z, Petrovic M, Medenica LM, Lens M. Surgical management of squamous cell carcinoma of the lip: analysis of a 10-year experience in 223 patients. J Oral Maxillofac Surg 2007;65:675-79.
  • 14. Bombeccari GP, Candotto V, Giannì AB, Carinci F, Spadari F. Accuracy of the Cone Beam Computed Tomography in the Detection of Bone Invasion in Patients With Oral Cancer: A Systematic Review. Eurasian J Med 2019;51: 298-306.
  • 15. Simsek M, Tekin SB, Bilici M. Immunological Agents Used in Cancer Treatment. Eurasian J Med 2019;51:90-4
  • 16. Blomberg M, Nielsen A, Munk C, Kjaer SK. Trends in head and neck cancer incidence in Denmark, 1978-2007: Focus on human papillomavirus associated sites. Int J Cancer 2011; 129: 733-41.
  • 17. Regezi J,Sciubba J Oral Pathology. Clinical –Pathologic Correlations. Philedelphia,PA : Saunders; 1994.p 79-84.
  • 18. Salgarelli AC, Sartorelli F, Cangiano A, Pagani R, Collini M. Surgical treatment of lip cancer: our experience with 106 cases. J Oral Maxillofac Surg 2009 ; 67:840-45.
  • 19. Silapunt S, Peterson SR, Goldberg LH. Basal Cell carsinoma on the vermilion lip: a study of 18 cases J Am Acad Dermatology 2004;50:384-87.
  • 20. Effiom OA, Adeyemo WL, Omitola OG, Ajayi OF, Emmanuel MM, Gbotolorun OM. Oral squamous cell carcinoma: a clinicopathologic review of 233 cases in Lagos, Nigeria. J OralMaxillofac Surg 2008; 66: 1595-99.
  • 21. Yoon DY, Hwang HS, Chang SK, Rho Y-S, et al. CT, MR, US,18FFDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Eur Radiol 2009;19:634–42.
  • 22. Jennings L, Schmults CD. Management of high-risk cutaneous squamous cell carcinoma. J Clin Aesthet Dermatol 2010;3:39–48.
  • 23. Yılmaz S, Ercocen AR. Selective Neck dissection in T1-2,No patients with Lower Lip Cancer necessary? Ann Plast Surg 2009;62:381-83.
  • 24. Vanderlei JP, Pereira-Filho FJ, da Cruz FA, et al. Management of neck metastases in T2N0 lip squamous cell carcinoma. Am J Otolaryngol 2013; 34: 103-6. 25. Kroll,S (Ed) Lip reconstruction. In Reconstructive Plastic Surgery for Cancer. St. Louis, Mo: Mobsy Year Book,1996; 201-209.
  • 26. Calhoun KH, Stiernberg CM. Surgery of the lip. New York (NY): Thieme Medical Publishers; 1992.
  • 27. Neligan PC. Strategies in lip reconstruction. Clin Plast Surg 2009;36:477–85.
  • 28. Furuta S, Sukaguchi Y, Imasarva M, et al. Reconstruction of the lips, oral commissure, and full-thickness cheek with a composite radial forearm-palmaris longus free flap. Ann Plast Surg 1994;33:544–47.
Birincil Dil en
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Orcid: 0000-0003-3095-6524
Yazar: Tuğba GÜN KOPLAY (Sorumlu Yazar)
Kurum: Sağlık Bakanlığı, Konya şehir Hastanesi
Ülke: Turkey


Orcid: 0000-0001-9347-5192
Yazar: Mehtap ŞEN
Kurum: SELCUK UNIVERSITY
Ülke: Turkey


Tarihler

Kabul Tarihi : 16 Ekim 2020
Yayımlanma Tarihi : 30 Ocak 2021

AMA Gün Koplay T , Şen M . PROBLEMS RELATED TO SURGERY AND PATHOLOGY IN LIP CANCER PATIENTS AND THEIR MANAGEMENT. J Contemp Med. 2021; 11(1): 12-17.