Changing trends in the management of carcinoma of the oral cavity and oropharynx.
Two groups of patients with squamous cell carcinoma of the oral cavity and oropharynx treated by radical surgery were studied. Special emphasis was placed on analysing changing trends in reconstruction and the management of the mandible and their influence on complication rates, length of hospital stay and tumour control rates. Group 1 consisted of 97 patients treated between 1980 and 1984 and Group 2 consisted of 153 patients treated between 1987 and 1991. Anatomical distribution of cancers and clinical stages were similar in the two groups. The major trends identified were: (i) the increasing use of free flaps for reconstruction (0 in Group 1, 41% in Group 2); (ii) more conservative mandibular resection and the increasing use of mandibular swing procedures (1% in Group 1, 16% in Group 2) rather than segmental mandibular resection (44% in Group 1, 13% in Group 2); (iii) fewer procedures per patient (2.6 per patient in Group 1, 1.2 per patient in Group 2); and (iv) a decrease in mean duration of hospital stay from 34 to 16 days and fewer complications. Patients in Group 2 also had a lower rate of local recurrence of cancer when compared with patients in Group 1 (19 vs 29%).
O'Brien
C J
CJ
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Nettle
W J
WJ
Lee
K K
KK
D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008334:Mandible / Q000601:surgery*; D008485:Medical Audit; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods* / Q000639:trends