Evrim ÜNSAL TUNA, Özgür ÖKSÜZLER, Cem ÖZBEK, Cafer ÖZDEM

Alt dudak kanserlerine cerrahi yaklaşım

Amaç: Alt dudak kanserlerinde cerrahi tedavi ve sonuçları değerlendirildi.Hastalar ve Yöntemler: Çalışmaya primer alt dudak kanseri tanısıyla ameliyat edilen 47 hasta alındı. Beş hastaya %10 ameliyat sonrası adjuvan radyoterapi uygulandı. Hastalar, klinik veriler, risk faktörleri, tümörün dudaktaki yerleşim yeri, bölgesel lenf nodları, klinik ve radyolojik evreleme, cerrahi tedavi ve patoloji sonuçları, lokorejyonel nüks ve prognoz açısından gözden geçirildi. Ortalama izlem süresi 60.1 ay dağılım 6-110 ay idi.Bulgular: Tüm hastalarda tümör yassı epitel hücreli karsinom idi. Tümörler 39 hastada %83 iyi, yedi hastada %15 orta, bir hastada %2 az derecede diferansiye idi. Yirmi dokuz hastada %61 evre 1 tümör saptandı. Hastaların 31’i T1, 14’ü T2, ikisi T3; 40’ı N0, altısı N1, biri N2 idi. Klinik olarak N0 olguların üçünde %7 , N1 olguların dördünde %66 histopatolojik lenf nodu metastazı saptandı. Klinik olarak N2olan hastada ekstrakapsüler uzanım vardı. Üç hastada %6 perinöral invazyon görüldü. Lokal nüks evre 2’de bir hastada %9 , evre 3’te bir hastada %16 görüldü. Üç hastada %6 boyunda nüks gelişti. Evre 4’deki bir hastada tanıdan iki yıl sonra uzak metastaz gelişti. Beş hasta %10 alt dudak kanseri nedeniyle, yedi hasta %15 diğer nedenlerden dolayı kaybedildi. Yaşayan 35 hastanın 34’ü %72 hastalıksızdı.Sonuç: Alt dudak kanseri tedavisinde cerrahi tedavi, çeşitli avantajlarının olması nedeniyle ilk seçenek olarak düşünülmelidir

Anahtar Kelimeler:

Karsinom, skuamöz hücreli, dudak neoplazileri/cerrahi, lenfatik metastaz, neoplazi evrelemesi

Surgical management of lower lip cancers

Objectives: We evaluated the results of surgical treatment of lower lip cancers. Patients and Methods: The study included 47 patients 7 females, 40 males; mean age 53 years; range 34 to 71 years who underwent surgery for primary lower lip carcinoma. Five patients received postoperative adjuvant radiotherapy. Data were reviewed on clinical features, risk factors, localization of the lesion, regional lymph node status, tumor staging, results of surgical treatment and pathological examination, locoregional recurrence, and prognosis. The mean follow-up period was 60.1 months range 6 to 110 months . Results: Histopathologic diagnosis was squamous cell carcinoma in all cases. Tumor differentiation was good in 39 patients 83% , moderate in seven patients 15% , and poor in one patient 2% . Stage 1 tumor was seen in 29 patients 61% . T and N staging were as follows: 31 T1, 14 T2, 2 T3; 40 N0, 6 N1, and 1 N2. Histopathologically, three N0 patients 7% , four N1 patients 66% had lymph node metastasis, and one N2 patient had extracapsular invasion. Three patients 6% had perineural invasion. Local recurrence developed in one stage 1 patient 9% and in one stage 2 patient 16% . Neck recurrence was seen in three patients 6% . One stage 4 patient developed distant metastasis two years after the diagnosis. Mortality occurred due to lip cancer in five patients 10% , and to other causes in seven patients 15% . Of 35 patients who survived, 34 72% were disease-free. Conclusion: Due to its advantages, surgery should be the treatment of choice for cancers of the lower lip of any stage.

Keywords:

Carcinoma, squamous cell, lip neoplasms/ surgery, lymphatic metastasis, neoplasm staging,

PDF

___

Wurman LH, Adams GL, Meyerhoff WL. Carcinoma of the lip. Am J Surg 1975;130:470-4.
Zitsch RP 3rd. Carcinoma of the lip. Otolaryngol Clin North Am 1993;26:265-77.
Renner GJ, Zitsch RP III. Cancer of the lip. In: Myers EN, Suen JY, editors. Cancer of the head and neck. 3rd ed. Philadelphia: W. B. Saunders; 1996. p. 294-320.
Jorgensen K, Elbrond O, Andersen AP. Carcinoma of the lip. A series of 869 cases. Acta Radiol Ther Phys Biol 1973;12:177-90.
Baker SR, Krause CJ. Carcinoma of the lip. Laryngoscope 1980;90:19-27.
Hendricks JL, Mendelson BC, Woods JE. Invasive carcinoma of the lower lip. Surg Clin North Am 1977; 57:837-44.
Luce EA. Reconstruction of the lower lip. Clin Plast Surg 1995;22:109-21.
Jesse RH. Extensive cancer of the lip. Surgical therapy. Arch Surg 1967;94:509-16.
American Joint Comittee on cancer. Lip and oral cav- ity. In: Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ, editors. Manual for staging of cancer. 3rd ed. Philadelphia: J. B. Lippincott; 1988. p. 27-32.
Hosal IN, Onerci M, Kaya S, Turan E. Squamous cell carcinoma of the lower lip. Am J Otolaryngol 1992; 13:363-5.
Bayçın N, Aygıt AC, Demiralay A, Afshari Y. Alt dudak kanserlerinin tedavisinde cerrahi yaklaşım. Trakya Univ Tip Fak Derg 2001;18:101-9.
Altaş E, Aktan B, Üçüncü H, Şirin S, Akşan M, Kalkandelen S. Dudak kanserleri. Atatürk Üniv Tıp Derg 1997;29:527-30.
Cruse CW, Radocha RF. Squamous cell carcinoma of the lip. Plast Reconstr Surg 1987;80:787-91.
Molnar L, Ronay P, Tapolcsanyi L. Carcinoma of the lip. Analysis of the material of 25 years. Oncology 1974;29:101-21.
Dick DA. Clinical and cosmetic results in squamous cancer of the lip treated by 140kV. radiation therapy. Clin Radiol 1962;13:304-12.
Esclamado RM, Krause CJ. Lip cancer. In: Bailey BJ, editor. Head and neck surgery-otolaryngology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1299-310.
Langdon JD, Ord RA. The surgical management of lip cancer. J Craniomaxillofac Surg 1987;15:281-7.
Guney E, Yigitbasi OG. Functional surgical approach to the level I for staging early carcinoma of the lower lip. Otolaryngol Head Neck Surg 2004;131:503-8.
de Visscher JG, Botke G, Schakenraad JA, van der Waal I. A comparison of results after radiotherapy and sur- gery for stage I squamous cell carcinoma of the lower lip. Head Neck 1999;21:526-30.
Koc C, Akyol MU, Celikkanat S, Cekiç A, Ozdem C. Role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip. Ann Otol Rhinol Laryngol 1997;106:787-9.
Brown RG, Poole MD, Calamel PM, Bakamjian VY. Advanced and recurrent squamous carcinoma of the lower lip. Am J Surg 1976;132:492-7.
Creely JJ Jr, Peterson HD. Carcinoma of the lip. South Med J 1974;67:779-84.
Heller KS, Shah JP. Carcinoma of the lip. Am J Surg 1979;138:600-3.
Stein AL, Tahan SR. Histologic correlates of metastasis in primary invasive squamous cell carcinoma of the lip. J Cutan Pathol 1994;21:16-21.
Califano L, Zupi A, Massari PS, Giardino C. Lymph- node metastasis in squamous cell carcinoma of the lip. A retrospective analysis of 105 cases. Int J Oral Maxillofac Surg 1994;23:351-5.
de Visscher JG, van den Elsaker K, Grond AJ, van der Wal JE, van der Waal I. Surgical treatment of squamous cell carcinoma of the lower lip: evaluation of long-term results and prognostic factors - a retrospective analysis of 184 patients. J Oral Maxillofac Surg 1998;56:814-20.