Palliative surgery for advanced tumours of the oral cavity

Abstract

INTRODUCTION: With better education and improved self-awareness, a greater proportion of patients present themselves earlier in the course of disease. However, there remains a group of patients who present with advanced tumour when the role of surgery is not well defined. This study reports our experience with surgery as palliation for advanced tumours in the oral cavity. METHODS: Over the last 2 decades, we have performed palliative surgeries on 34 patients with advanced tumours of the oral cavity. The tumour pathology, mode of resection and reconstruction, symptom palliation and hospital stay were retrieved and data were analyzed retrospectively. RESULTS: Among our patients, 14 (41.2%) had squamous cell carcinoma (SCC) of the tongue, 8 (23.5%) had radiation induced sarcoma, 6 (17.6%) had SCC of the maxillary sinus, 4 (11.8%) had SCC of the inferior alveolus and 2 (5.9%) had SCC of the buccal mucosa. Six patients have systemic metastasis found during pre-operative workup. The major symptoms for palliation included bleeding (n = 14), pain (n = 12), airway obstruction (n = 4), swallowing problem (n = 2) and fungating tumour (n = 2). Majority of the patients (88.2%) required various methods of reconstruction to maximize post-operative functional outcome, among which, the pectoralis major myocutaneous flap was the most popular option. The mean hospital stay was 18.2 days and there was no hospital mortality. Postoperative chemo-irradiation was given in 26 patients. Mean duration of survival was 18.8 months. All patients achieved satisfactory palliation of symptoms, including haemostasis and avoidance of analgesia, tracheostomy and nasogastric feeding tubes. DISCUSSION: In selected patients presenting with advanced stage malignancies of the oral cavity, carefully planned surgical treatment achieves satisfactory palliation of symptoms, thereby improving their quality of life during the subsequent time to come.