DUDAK KANSERİ HASTALARINDA CERRAHİ VE PATOLOJİYE İLİŞKİN SORUNLAR VE YÖNETİMİ

Giriş: Dudak kanserleri baş boyun bölgesinde ikinci sıklıkta görülen kanserlerdir. Fonksiyonel ve estetik sonuçları ve agresif seyri sebebiyle cerrahi eksizyon sınırları, boyun diseksiyonu tipi ve rekonstrüksiyon seçenekleri gibi klinik yaklaşım tipleri dudak kanseri hakkında tartışılan konulardır. Çalışmada cerrahi öncesi yapılan değerlendirmelerin güvenilirliği, rekürrens ve metastaz için risk faktörleri, cerrahiye bağlı morbiditeler ve tedavileri araştırıldı. Method: Kliniğimizde tedavi edilen bazal hücreli karsinom ve squamoz hücreli karsinom tanılı hastaların verileri retrospektif olarak tarandı. Hastaların demografik verileri değerlendirildi, punch biyopsi ve radyolojik görüntülemelerin güvenilirliği tartışıldı ve patolojik özelliklerin rekürrens ve metastaz risk üzerine etkileri araştırıldı. Cerrahi sonrası morbiditeler değerlendirilerek tüm bu problemler ve çözüm yolları literatür eşliğide tartışıldı. Sonuç: Bu çalışmada punch biyopsi güvenilir bulunmadı. Rekürrensler ileri evre ve perinöral invazyon ile, servikal metastazlar ise çıkartılan lezyon boyutu ve cerrahi sınır ile ilişkili bulundu. Lokal fleplerde donor alan morbiditeleri daha yüksekti. Geniş eksizyon, boyun diseksiyonu ve serbest flep ile rekonstrüksiyon yapılan hasta grubunda rekürrens veya metastaz gözlenmedi. Tartışma: Erken tanı ve fonksiyonel-estetik onarım dudak kanseri prognozunda en önemli faktörlerdir. Yapılan ilk cerrahi prognozu belirlediğinden çok önemlidir. Evre ilerledikçe cerrahi kompleksleşir fakat iyi bir klinik yaklaşım ile erken evreler kadar iyi bir prognoz sağlanabilir.

Anahtar Kelimeler:

Dudak, Kanser, Prognoz, Rekonstruksiyon

PROBLEMS RELATED TO SURGERY AND PATHOLOGY IN LIP CANCER PATIENTS AND THEIR MANAGEMENT

Purpose: Lip cancers are the second most common cancers of head and neck region. Due to its functional and aesthetic consequences and aggressive course, clinical approach including surgical margins, type of neck dissection and reconstruction techniques are debated topics in lip cancer. We investigated reliability of preoperative evaluations, pathological risk factors for recurrence or metastasis, surgery related morbidities and their management. Methods: The records of patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were reviewed retrospectively. Demographic data of the patients were evaluated, the reliability of the punch biopsy and radiological imaging was discussed and the effects of pathological features on the risk of recurrence and metastasis was investigated. Surgery related morbidities were revealed. All these problems and their solutions were discussed in the light of literature. Results: Punch biopsy was found unreliable in this study. Relapses were associated with advanced stage and perineural invasion while cervical metastasis was related with the size of the specimen and surgical margins. Donor site morbidities were higher in local flaps. Recurrence or metastases were not observed in patients who were treated with extensive excision, neck dissection and reconstruction with free flap. Conclusions: Early diagnosis and functional and aesthetic repair are the most important factors in terms of prognosis in lip cancer. First surgery is very important that determines the prognosis. As the stage progresses, the surgery becomes complex but prognosis can be as good as early stages with good clinical approach.

Keywords:

Lip Cancer, Prognosis, reconstruction, Techniques,

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