Tissue-conserving surgery for prognosis, treatment, and function preservation.
OBJECTIVE
To describe an approach based on initial tissue-conserving surgery used to obtain histologically determined prognostic information that has therapeutic implications and the potential to enhance preservation of function.


METHODS
Analysis of a group of patients with head and neck cancer treated initially with tissue-conserving surgery based on Mohs' histographic sectioning and selected neck dissection to derive histologically determined prognostic information with therapeutic implications and preservation in function.


METHODS
This study is primarily based on an analysis of patients from January 1, 1989, through June 4, 1996 assigned to a protocol evaluating resection of oral cavity squamous cell cancer with margin control using Mohs' histographic technique and/or a group of patients with neck assessment of NO on clinical examination who are undergoing supraomohyoid neck dissections.


RESULTS
Thirty-three primary tumor resections were performed using the Mohs' technique, and 54% required two or more Mohs' sections before clear histologic margins were obtained following resection based on clinically determined negative margins. There were 44 patients who underwent unilateral or bilateral supraomohyoid neck dissections, and 33% had occult, histologically positive nodes. When compared with the disease of the neck specimens, a preoperative computed tomography scan had a sensitivity of 25%, a specificity of 77%, and an accuracy of 63%.


CONCLUSIONS
This report describes the effectiveness of Mohs' histographic sectioning and selective neck dissection as a means of determining prognostic information that can be used to develop a focused and cost-effective treatment program that, along with contemporary reconstructive techniques, provides a potential enhancement of function preservation.
Schuller
D E
DE
Department of Otolaryngology, Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Research Institute, The Ohio State University, Columbus 43210, USA.
Bier-Laning
C M
CM
Sharma
P K
PK
Siegle
R J
RJ
Pellegrini
A E
AE
Karanfilov
B
B
Bellisari
G
G
Miller
R
R
Young
D C
DC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000556:secondary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009055:Mouth / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011300:Preoperative Care; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome