Radical resection of advanced tongue cancer and one-stage total tongue reconstruction

Abstract

Abstract Background:The dysfunction of the tongue caused after total tongue resection is a major challenge for surgeons.The purpose of this study was to explore the functional recovery and survival of patients after radical resection of advanced tongue cancer and one-stage total tongue reconstruction with laryngeal preservation. Methods:Twelve cases of tongue reconstruction with pectoralis major myocutaneous (PMMF) flap or anterolateral thigh (ALT) flap from 2012 to 2020 were analyzed. The speech function, tongue flexibility, deglutition, and patient satisfaction with the donor appearance were evaluated at 3 and 6 months after operation.The survival status was recorded at 1,3, and 5 years after surgery. Results:There were 7 males and 5 females, with an average of 48.75 years. 5 cases with (PMMF) flap , and 7 cases with (ALT) flap ,the overall flap survival rate was 100% (12 / 12). Postoperative tracheal tube removal rate was 100%(12 / 12).9 cases had a history of secondary or even multiple surgeries or chemoradiotherapy,8 cases concomitanted adjuvant chemoradiotherapy after surgery.Pathological types included:10 cases of squamous cell carcinoma , 1 case of sarcomatoid carcinoma(SC) and 1 case of adenoid cystic carcinoma（ACC）. At 6 months after surgery, 3 (27.2%) of 11 patients (1 dead at 4 months) had normal language, 4 (36.4%) had near-normal language, and 4 (36.4%) had vague speech. In addition, 3 (27.2%) patients had a normal diet, 1 (9.1%) patient had a soft diet, 6 (54.5%) patients had a liquid diet, and 1 (9.1%) patient still required tube feeding. Six months after the operation, the tongue was basically in a fixed state, and the range of motion of the tongue did not improve significantly(P=0.217). The patients' satisfaction with the recovery of the donor site was (10/11) 90.9%.Compared with three months after surgery,the articulation of speech（P=0.024）, swallowing, chewing and eating （P=0.033）were significantly improved at six months after surgery . The 1-year, 3-year and 5-year survival rates were 66.66%, 33.33% and 25.0%, respectively. Conclusion:Total glossectomy is most often used as salvage therapy in patients with stage IV primary cancer or in recurrent cases.Reconstruction after total glossectomy using larger tissue flaps such as ALT or PMMF flaps has acceptable risk of complications and affords most patients the potential for intelligible speech and tube-feed-free nutrition with improved quality of life and reasonable long-term survival.