The Survival Analysis And Function Evaluation Of Early Stage Tongue Cancer Underwent Tongue, Neck Non-continuous Radical Resection And Reconstructed With Tongue Crossed Flap After Glossectomy

PURPOSE: To study the prognosis of patients who underwent tongue, neck non-continuous radical resection of early stage tongue squamous cell carcinoma and to analyze the influencing factors of prognosis. And to evaluate the postoperative speech function and tongue movement function of patients after reconstruction with different methods.METHODS: From December 1999 to December 2009, 179 patients who underwent tongue, neck non-continuous radical resection of early stage tongue squamous cell carcinoma at Oral and Maxillofacial Surgery Ward, Shanghai Ninth People’s Hospital were included in this retrospective study. Complete clinical and follow-up data were collected. The survival rate was calculated with life table method, while univariate and multivariate analyses were performed to screen prognostic factors using SPSS20.0 software package. From July 2012 to December 2014, 48 patients who underwent partial glossectomy and reconstruction with different methods were included in another study of postoperative functional evaluation. The results were compared according to the reconstructive methods: reconstruction with tongue crossed flap(16 cases), primary closure(8 cases), submental island flap(8 cases), forearm flap(8 cases) or pectoralis major myocutaneous flap(PMMF)(8 cases). Tongue maximum protrusion distance while maximum opening mouth and tip of the tongue deviation from the mid line were used as evaluated method of tongue movement function. The speech intelligibilities were investigated before and after operation with a speech intelligibility test formed by 100 sensitive Chinese words as evaluation method of speech function. The data were analyzed by ANOVA with SPSS20.0 software package.RESULTS: 1. 1, 2, 3, 5-year survival rates of 179 patients with early stage tongue cancer were 96%, 91%, 84%, and 74%, respectively. T stage, pathological grading, tumor invasive depth, local or regional recurrence were the prognostic factors(log-rank test, P<0.05) using univariate analysis. Mulitivariate analysis showed pathological grading, tumor invasive depth, local or regional recurrence were the independent factors, which had a close relationship with prognosis(Cox model, P<0.05).2. According to speech intelligibility and tongue maximum protrusion distance, no significant difference was observed among tongue crossed flap, submental island flap and forearm flap. But tongue crossed flap has significant advantage over simple suture and PMMF(P<0.05). According to tip of the tongue deviation from the mid line, only primary closure has significant disadvantage over other reconstructive methods(P<0.05).CONCLUSION: 1. In this study, 1, 2, 3, 5-year survival rates of 179 patients with early stage tongue cancer were 96%, 91%, 84%, 74%, respectively.2. The method of tongue, neck non-continuous radical resection can be used for treatment of early stage tongue squamous cell carcinoma(c T1-2N0M0 and primary tumor without involving mouth floor)with better postoperative quality of life.3. T stage, pathological grading, tumor invasive depth, local or regional recurrence are prognostic factors. pathological grading, tumor invasive depth, local or regional recurrence are independent factors, which have a close relationship with prognosis.4. Tongue crossed flap is applicable to reconstruct the defects of tongue cancer ≤T2 stage after partial glossectomy. Inferior to submental island flap and forearm flap, tongue crossed flap has an advantage over primary closure and PMMF in speech intelligibility and tongue movement function. Reconstruction with tongue crossed flap, which greatly shorten the operation time, reduce the surgical trauma and risk, is an ideal method.