Combination treatment with glossectomy, laryngectomy and subtotal mandibulectomy in patients after unsuccessful treatment of locally advanced cancer of the oral mucosa

Introduction. Despite the advancements in science and technology, results of antitumor treatment of recurrent oral squamous cell carcinoma (rOSCC) remain unsatisfactory: patient survival is very low. In cases of recurrent disease, single-step glossectomy, subtotal segmental mandibulectomy and laryngectomy are feasible.

Aim. To analyze the results of combination surgical treatment of rOSCC using glossectomy, subtotal segmental mandibulectomy and laryngectomy after previous unsuccessful antitumor treatment to improve outcomes of treatment of recurrences and continued growth of locally advanced cancer.

Materials and methods. Single-center prospective study was conducted. It included patients with recurrent squamous cell carcinoma of the oral mucosa and larynx with indications for antitumor treatment using multicomponent surgical intervention in the framework of comprehensive treatment. The case of the treatment of recurrent laryngeal cancer served as a prototype for the development of techniques for simultaneous glosectomy, segmental resection of the mandible and laryngectomy. Two patients had malignant neoplasms of the oral mucosa: in one case, stage рT3N0M0 III tongue cancer, condition after hemiglossectomy, level I–II–III cervical lymph node dissection and radiotherapy; in the other case, stage рT3N0M0 III rOSCC after radiation therapy.

Results. During surgery, skin resection was performed above the tumor component of the submandibular area due to signs of derma invasion and danger of penetrating growth with intradermal dissemination caused by postradiation edema. For defect reconstruction, in 1 patient with laryngeal cancer and 1 patient with rOSCC, pectoralis major myocutaneous flap was used. In 1 case of rOSCC, due to rapid wight loss during radiation therapy, primary reconstruction with pharyngostomy formation with total defect of the tongue, mandible and larynx was not performed. Local purulent and necrotic postoperative complications were observed in all 3 patients. In the first 30 days after the surgery, 1 patient with rOSCC died at the hospital; 30-day mortality after combination surgeries was 33 %. Another patient with rOSCC died 2.5 months after discharge, a little more than 90 days (3.5 months) after the surgery. The patient with laryngeal cancer is currently alive without signs of disease.

Conclusion. The surgical interventions described are life-saving surgeries due to exhausted capabilities of radiation therapy, supposed low efficacy of antitumor drug therapy in the presence of a mass of crumbling tissues.