Approach to the primary mass and neck in lower lip cancers: analysis of 24 cases

Yıl 2009, Cilt: 19 Sayı: 5, 227 - 231, 23.10.2009

Çağatay Han Ülkü Yavuz Uyar

Öz

Objectives: In this study, we analyzed the surgical approach which we carried out for treatment of the primary mass and neck in 24 lower lip cancer cases and its results. Patients and Methods: 24 patients 5 females, 19 males; mean age 56.8; range 41 to 72 years who were operated on in our clinic for lip cancer between March 1995 and March 2007 and whom we were able to long term follow-up were included in this study. Tumor was resected with 1-2 cm surgical margin in all cases. The tissue defect was reconstructed by either primary closure or local/regional flaps. If the tumor was located in the middle of the lip, bilateral neck dissection, otherwise unilateral neck dissection was performed. Postoperative radiotherapy was used in cases who had neck metastatic disease. Functional results were evaluated regarding recurrence and mortality rates during five-year mean follow-up period. Results: Tumor was originated from the lower lip alone in 20 cases. There was secondary commissure involvement in four cases. According to the TNM tumor, node, metastasis classification AJCC, 2002 , distribution of the cases was T1N0M0 n=10 , T2N0M0 n=9 , T3N1M0 n=3 , T4N2aM0 n=1 , T4N2cM0 n=1 . Primary closure n=7 , Abbe-Estlander flap n=9 , Karapandzic flap n=4 , Melolabial flap n=3 , Fan flap n=1 , pectoralis major myocutaneous flap n=2 were used as reconstruction techniques. Histopatologically, metastatic disease was determined in the neck in four cases. During the follow-up period, there occurred ocal recurrence in two cases and regional metastasis in one. Two cases with distant metastasis died. Survival rates without illness for early and advanced stage tumors were 100% and 20%, respectively. Functional results after reconstruction were satisfactory, except in two cases which we used pectoralis major myocutaneous flap for reconstruction. Conclusion: Five-years survival rates without illness were significantly lower in cases with advanced stage tumor and N positive neck. This result indicates that stage of the tumor and neck involvement have a significant effect on prognosis. Furthermore, more satisfactory functional results were achieved in early stage tumors.

Anahtar Kelimeler

Lip cancer, reconstruction, surgery

Alt dudak kanserlerinde primer kitle ve boyna yaklaşım: 24 olgunun analizi

Öz

Amaç: Bu çalışmada 24 alt dudak kanseri olgusunda primer kitle ve boyun tedavisi için uyguladığımız cerrahi yaklaşım ve sonuçları analiz edildi.Hastalar ve Yöntemler: Kliniğimizde, Mart 1995-Mart 2007 tarihleri arasında alt dudak kanseri tanısıyla ameliyat edilen ve uzun süre takip edilebilen 24 hasta 5 kadın, 19 erkek; ort. yaş 56.8; dağılım 41-72 yıl bu çalışmaya dahil edildi. Cerrahi olarak tümör, 1-2 cm’lik güvenlik sınırı bırakılarak çıkarıldı. Oluşan doku eksikliği primer kapama ya da lokal veya bölgesel flepler ile onarıldı. Tümör dudağın bir tarafında ise tek, orta hatta yakın ise iki taraflı boyun diseksiyonu yapıldı. Boyunda yayılım saptanan olgularda ameliyat sonrası radyoterapi uygulandı. Fonksiyonel sonuçlar, beş yıllık ortalama takip süresinde yineleme ve mortalite oranları yönünden değerlendirildi.Bulgular: Tümör, 20 olguda izole alt dudaktan kaynaklanıyordu. Dört olguda ikincil komissür tutulumu saptandı. TNM tümör, nodül, metastaz sınıflamasına AJCC, 2002 göre, olguların dağılımı; T1N0M0 n=10 , T2N0M0 n=9 , T3N1M0 n=3 , T4N2aM0 n=1 , T4N2cM0 n=1 idi. Onarım teknikleri olarak, primer kapama n=7 , Abbe-Estlander flep n=9 , Karapandzic flep n=4 , Melolabial flep n=3 , Fan flep n=1 , pektoralis majör miyokütanöz flep n=2 kullanıldı. Histopatolojik olarak dört olguda boyunda yayılım saptandı. Takip süresince, iki olguda lokal yineleme, bir olguda bölgesel yayılım gelişti. İki olgu uzak yayılım nedeniyle kaybedildi. Erken evre ve geç evre tümörlerde beş yıllık hastalıksız sağkalım oranları sırası ile %100 ve %20 idi. Onarım sonrası elde edilen fonksiyonel sonuçlar, pektoralis majör miyokütanöz flebi ile onarım yapılan iki olgu dışında tatminkardı.Sonuç: İleri evre tümöre ve N pozitif boyna sahip olgularda, beş yıllık hastalıksız sağkalım oranları belirgin olarak düşüktü. Bu sonuç, tümör evresi ve boyun tutulumunun prognoz üzerine olan etkisini vurgulamaktadır. Ayrıca, erken evre olgularda daha tatminkar fonksiyonel sonuçlar elde edildi

Anahtar Kelimeler

Dudak kanseri, rekonstrüksiyon, cerrahi

Kaynakça

• Alam M, Ratner D. Cutaneous squamous-cell carci- noma. N Engl J Med 2001;344:975-83.
• Spitzer WO, Hill GB, Chambers LW, Helliwell BE, Murphy HB. The occupation of fishing as a risk factor in cancer of the lip. N Engl J Med 1975;293:419-24.
• Keller AZ. Cellular types, survival, race, nativity, occu- pations, habits and associated diseases in the patho- genesis of lip cancers. Am J Epidemiol 1970;91:486-99.
• Zitsch RP 3rd, Park CW, Renner GJ, Rea JL. Outcome analysis for lip carcinoma. Otolaryngol Head Neck Surg 1995;113:589-96.
• Vukadinovic M, Jezdic Z, Petrovic M, Medenica LM, Lens M. Surgical management of squamous cell carci- noma of the lip: analysis of a 10-year experience in 223 patients. J Oral Maxillofac Surg 2007;65:675-9.
• Alho OP, Keränen MR, Kantola S, Riihimäki S, Jokinen K, Alho P, et al. Lip cancer in Northern Finland: chang- ing incidence and clinical characteristics. J Oral Pathol Med 2000;29:299-302.
• Cruse CW, Radocha RF. Squamous cell carcinoma of the lip. Plast Reconstr Surg 1987;80:787-91.
• Closmann JJ, Pogrel MA, Schmidt BL. Reconstruction of perioral defects following resection for oral squamous cell carcinoma. J Oral Maxillofac Surg 2006;64:367-74.
• Ezzoubi M, Benbrahim A, Fihri JF, Bahechar N, Boukind el H. Reconstruction after tumour’s excision in lip’s cancer: report of 100 cases. Rev Laryngol Otol Rhinol (Bord) 2005;126:141-6.
• Iwahira Y, Yataka M, Maruyama Y. The sliding door flap for repair of vermilion defects. Ann Plast Surg 1998;41:300-3.
• Zilinsky I, Winkler E, Weiss G, Haik J, Tamir J, Orenstein A. Total lower lip reconstruction with innervated muscle-bearing flaps: a modification of the Webster flap. Dermatol Surg 2001;27:687-91.
• Lupo G, Mazzola RF. Our experience with lip recon- struction. A lesson from history. Clin Plast Surg 1984; 11:619-35.
• Constantinidis J, Federspil P, Iro H. Functional and aesthetic objectives in the reconstruction of lip defects. Facial Plast Surg 1999;15:337-49.
• Larrabee WF, Sherris DA. Lips and chin. In: Larrabee WF, Sherris DA, editor. Principles of facial reconstruc- tion. Philadelphia: Lippincott-Raven; 1995. p. 170-219.
• Ono I, Ariga K, Gunji H, Hasegawa T, Sato M, Kaneko F. A method with three triangular flaps as a second- ary operative procedure after reconstruction of the lower lip by Estlander’s method. Plast Reconstr Surg 1992;90:700-6.
• Calhoun KH. Reconstruction of small- and medium- sized defects of the lower lip. Am J Otolaryngol 1992;13:16-22.
• Goldstein MH. The elastic flap for lip repair. Plast Reconstr Surg 1990;85:446-52.
• Ord RA. The pectoralis major myocutaneous flap in oral and maxillofacial reconstruction: a retrospec- tive analysis of 50 cases. J Oral Maxillofac Surg 1996; 54:1292-5.
• Aygıt AC, Güzel MZ, Bayramiçli M, Aydın Y, Yücel A. Alt dudak tam kayıplarının iki yanlı ‘fan flep’ ile onarımı. Cerrahpaşa J Med 1999;30:171-4.
• Dediol E, Luksic I, Virag M. Treatment of squamous cell carcinoma of the lip. Coll Antropol 2008;32(Suppl 2):199-202.
• Kocatürk S, Ozdemir N, Erkam U, Uzun H, Babila A, Oztürk E. Evaluation of occult lymph node metastasis in lower lip cancers and approach to N(0) neck metas- tasis. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2002;9:41-5.