Efficacy of Per Oral Access in the Surgical Management of T2/T3 Oral Cavity Squamous Cell Carcinoma

• Published in: Otolaryngology-head and neck surgery 2012-12, Vol.147 (6), p.1069-1075
• Main Authors: Battoo, Azhar J., Thankappan, Krishnakumar, Ahmad, Sheikh Zahoor, Hedne, Naveen, Balasubramanian, Deepak, Trivedi, Nirav, Iyer, Subramania, Kuriakose, Moni Abraham
• Format: Article
• Language: English
• Subjects: Adult; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; clear margins; close/involved margins; Female; Humans; Mouth; Mouth Neoplasms - pathology; Mouth Neoplasms - surgery; oral squamous cell carcinoma; per oral access; Retrospective Studies; T2/T3 carcinoma; Tongue Neoplasms - pathology; Tongue Neoplasms - surgery; Tumor Burden
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599812456812

Objective Transcutaneous “access” procedures still continue to be widely employed for surgical management of medium-sized (T2, T3) oral cavity tumors in spite of the almost 4-cm mouth opening available to the surgeon to access the oral cavity. We undertook a retrospective study to objectively evaluate “per oral access” in managing these tumors with regard to the ability to achieve a clear surgical margin and enable reconstruction of resultant defect. Study Design Case series with chart review. Setting Tertiary academic hospital. Subjects and Methods Seventy-nine consecutive patients of oral squamous cell carcinoma excised by per oral approach were analyzed. Multiple patient- and tumor-related factors known to influence status of surgical margins were analyzed. The overall frequency of clear, close, and involved margins was noted, as well as 5-year local control rate. The method of reconstruction employed was evaluated. Results The close/involved margins were more frequent with larger tumors and tumors exhibiting perineural infiltration, but none were statistically significant (P > .12). The overall frequency of clear, close, and involved margins was 81%, 11%, and 8%, respectively. Tongue and buccal mucosa sites constituted approximately 85% of the cases and had an 85% clear margin rate. Five-year local control rate was 70.35%. Fifty-three free flaps reconstruction were undertaken without any additional “access” procedure. Conclusion Our results demonstrate ability to obtain comparable tumor clearance rates employing per oral access, without compromising ability to perform optimal reconstruction. We suggest per oral access should be the access of choice for medium-sized oral cavity tumors, and additional access procedures should only be considered if the initial access proves inadequate.