Prognostic factors for surgically resected squamous cell carcinoma of the lower oral cavity.

AIM: The objective of this study was to evaluate the impact of clinical variables on survival rates in patients with squamous cell carcinomas in the lower oral cavity. METHODS: We conducted a retrospective study of patients who exhibited a histological diagnosis of squamous cell carcinoma of the lower oral cavity, who underwent surgery. Data on clinical, histological, and treatment variables were collected to assess the effect of these variables on global survival and disease-free curves. RESULTS: We studied 117 patients, 86 (73.5%) males and 31 (26.5%) females, who underwent surgery between January 2005 and June 2009. The overall survival rate was 74.4% after two years, and the disease-free rate was 67.5%. Midline invasion by the primary tumor negatively impacted overall survival (P=0.02) and disease-free survival (P=0.01). The disease-free survival rate of patients with histologically confirmed neck metastases was 76.8% versus 59% for patients without metastases (P=0.01). Disease-free survival of patients with one affected lymph node was 89.5%, and 45.2% for more than one affected lymph node (P<0.01). Patients who ended radiotherapy in less than 60 days exhibited a disease-free rate of 59.0%, and patients whose treatment lasted more than 60 days exhibited a rate of 77.1% (P=0.06). CONCLUSION: In our study, primary tumor invasion of the midline, the presence of more than one affected lymph node as confirmed by histology, the delaying radiotherapy for more than 56 days and radiotherapy that lasted longer than 60 days worsen patient prognosis.

Does early oral feeding increase the likelihood of salivary fistula after total laryngectomy?

Objective: This study compared the incidence of salivary fistula between groups with an early or late reintroduction of oral feeding, and identified the predictive factors for salivary fistula. Methods: A randomised trial was performed using 89 patients with larynx or hypopharynx cancer, assigned to 2 groups (early or late). In the early group, oral feeding was started 24 hours after total laryngectomy or total pharyngolaryngectomy, and in the late group, it was started from post-operative day 7 onwards. The occurrence of salivary fistula was evaluated in relation to the following variables: early or late oral feeding, nutritional status, cancer stage, surgery performed, and type of neck dissection. Results: The incidence of salivary fistula was 27.3 per cent (n = 12) in the early group and 13.3 per cent (n = 6) in the late group (p = 0.10). The following variables were not statistically significant: nutritional status (p = 0.45); tumour location (p = 0.37); type of surgery (p = 0.91) and type of neck dissection (p = 0.62). A significant difference (p = 0.02) between the free margins and invasive carcinoma was observed. Conclusion: The early reintroduction of oral feeding in total laryngectomised patients did not increase the incidence of salivary fistula.