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ROLE OF SURGERY IN ORAL CANCER

DR. M. VIJAYAKUMAR
M.B.B.S, DIP N.B.(GEN SURG)M.Ch (ONCO)

PROFESSOR OF SURGICAL ONCOLOGY KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY BANGALORE

SURGERY IN ORAL CANCER

WHAT
WHEN WHY HOW

TO DO ?

SURGERY IN ORAL CANCER


ESECT
ECONSTRUCT

EHABILITATE

SURGERY IN ORAL CANCER

ROLES

DIAGNOSIS STAGING TREATMENT

SURGERY IN ORAL CANCER


DIAGNOSIS

FNAC LN / NODULE TRUCUT INCISION EXCISION


BIOPSY

SURGERY IN ORAL CANCER


STAGING

IMAGING vs SURGICAL

SURGERY IN ORAL CANCER


DIFF MODALITIES IN LN EVALN

TECH
1.CLINICAL 2.C.T. SCAN 3.MRI 4.U/S GD FNAC

ACCURACY (%)
59 66 75 86

SURGERY IN ORAL CANCER


TREATMENT
IN PREVENTION AS PRI .TREAT. AS PART OF MULTIMODAL

TREAT. PREPN. FOR POST OP TREAT.

IN METASTATIC DISEASE

SURGERY IN ORAL CACNER


PREVENTION

LEUKOPLAKIA ERYTHROPLAKIA

SURGERY IN ORAL CANCER


AS PRI. MODALITY (T)

AIM
TO GET DISEASE FREE MARGIN

SURGERY IN ORAL CANCER


PROBLEMS
ACCESS BONE CHEEK
TRISMUS SITE / EXTENT MAXILLA MANDIBLE ANATOMY

SURGERY IN ORAL CANCER


ACCESS SOLUTIONS

ANAESTH

TRACHEOSTOMY
ENDOSCP ASSTD. INTBN

SURGERY

TRANSORAL CHEEK FLAPS VISOR FLAP MANDIBULECTOMY MANDIBULOTOMY

SURGERY IN ORAL CANCER


SOLUTIONS
BONE SACRIFICING vs SPARING

SURGERY IN ORAL CANCER


SOLUTIONS
CHEEK

< 1 cm W.E

THICK SUBOPTIMAL

SURGERY IN ORAL CANCER


OBJECTIVE
ONCOLOGICAL CONTROL FUNCTIONAL PRESERVN

COSMESIS

SURGERY IN ORAL CANCER


ONCOLOGICAL CONTROL III TUM FREE MARGINS III 1 cm W.E

SURGERY IN ORAL CANCER


MANAGING MANDIBLE REMOVE OR RETAIN
ACCESS / LYMPHATICS / INSTRUMENTS

SURGERY IN ORAL CANCER


MANAGING MANDIBLE

RETAIN WHENEVER POSSIBLE

REMOVE WHEN INVOLVED


- WHATS INVOLVED
HEMIPARTIALSEGMENTMARGINAL

SURGERY IN ORAL CANCER


LN MANAGEMENT
NECK DISSECTION

RND / CLASSICAL ND

MND TYPES I ACC. N


II ACC. N + IJV III ACC. N + IJV + SM

COMPREHENSIVE

SURGERY IN ORAL CANCER


LN MANAGEMENT NECK DISSECTION

SUPRAHYOID SUPRAOMOHYOID

PARTIAL NECK DISSECTION

SURGERY IN ORAL CANCER


NECK
N ve
= N +ve = STAGING NECK DISS SOND THERAPEUTIC ND CND / ? MND - I

SURGERY IN ORAL CANCER


COMBINED OPERATIONS

IN CONTINUITY

COMPOSITE RESECTION (COMMANDO OPERATION)

T + N + MAND.

DISEASE REMVD . EN BLOC


CONTD

SURGERY IN ORAL CANCER


DISCONTINUOUS
W.E. OF TUM + NECK DS

MANDIBLE SPARED
DIS. REMVD IN TWO PIECES

SURGERY IN ORAL CANCER


T

RATIONALE

1 cm MARGIN . ANAT/ PATH REASONS EXCEPTION = TONGUE

SURGERY IN ORAL CANCER


SOND STAGING LEVEL I COMMOMNLY INVLD.
TO GET ATLEAST TWO LEVELS FREE
N

RND/MND THERAPEUTIC > I LEVEL INVLD RISK FOR > I LN INVLD REC. > 2-3 cm SIZE

SURGERY IN ORAL CANCER


MARGINS MACROS MICROS COMMONLY SPOKEN

MOLECULAR

SURGERY IN ORAL CANCER


TOOLS

COLD KNIFE ELECTROCAUTERY LASER HARMONIC SCALPEL CRYOSURGERY

SURGERY IN ORAL CANCER

TREAT. AIM

CURE PALLIATION PROLONGATION

SURGERY IN ORAL CANCER


MULTIMODAL TREAT.

RATIONALE SINGLE MOD. = FAILURE INDICATIONS LOCALLY ADV. DISEASE T3 / T4 N2 / N3

SURGERY IN ORAL CANCER


MULTIMOD. TREAT.
SEQUENCING = CONTROVERSIAL

INSTITUTIONAL INDIVIDUAL

BIAS

NO CONSENSUS

SURGERY IN ORAL CANCER


PREPARATION FOR POST OP TRET.

CLIPS IN TUMOUR BED VENOUS ACCESS FOR C.T

SURGERY IN ORAL CANCER

USEFUL GUIDELINES

SURGERY IN ORAL CANCER

PRIMARY
T1 T2 T3 T4 SURG. OR R.T <3CM TREAT AS T1 >3CM - SURG + RT SURGERY +RT OR CON. RT + CT
SURGERY+RT OR ANT. CT SURG.+RT OR CON.RT+CT SURG.

SURGERY IN ORAL CANCER

NECK - LN
NO N1 N2 N3
LOW RISK WAIT & WATCH CND +/- RT MOBILE CND + RT a) MOBILE SAME AS N 2 b) FIXED OPTIONS : *PALL. RT OR *ANT. CT MOBILE & TREAT AS IN (a) *OR CON. RT+CT PROCEED

SURGERY IN ORAL CANCER


HOLISTIC APPROACH
HOST - AGE / PS / ORGAN

TUMOUR TYPE / SITE/ GRADE

TREAT. S / RT/ CT

THANK YOU