Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience

Shiv Rajan; Puneet Prakash; Naseem Akhtar; Vijay Kumar; Sameer Gupta; Arun Chaturvedi; Dhruv Mahajan; Resham Srivastava; Sumaira Qayoom; Deep Chakrabarti; Shirin Parveen

doi:10.4103/njms.NJMS_114_20

Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience

Natl J Maxillofac Surg. 2021 Jan-Apr;12(1):72-77. doi: 10.4103/njms.NJMS_114_20. Epub 2021 Mar 16.

Authors

Affiliations

¹ Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
² Department of Radiation Oncology, MPMMCC and HBCH, Varanasi, Uttar Pradesh, India.
³ Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.
⁴ Department of Radiation Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
⁵ Department of Anesthesiology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India.

Abstract

Backgrounds: Oral squamous cell cancer (SCC) is one of the most common cancers. The most common age of presentation is fifth to sixth decade. Management of this disease is dictated by stage, age, and related comorbidities. Elderly patients have their own set of limitations as far as their management is concerned. Carcinoma involving central mandibular arch is a challenging disease for surgeons, especially in the elderly. This article describes our experience with the surgical treatment of oral cancer involving the central arch of the mandible in elderly patients.

Methods: Forty elderly (≥60 years) patients with histologically proven SCC of the oral cavity in which disease was involving the central arch of the mandible, were included in our study. Demographic, clinical, and treatment-related factors were recorded. The outcome was assessed in terms of postoperative complications, recurrence, and patient survival.

Results: The median age of the patients was 63 years. The male:female ratio was 7:3. A history of oral tobacco use was present in 95% of patients. The most common site of disease was lower alveolus (80%) followed by carcinoma of the lower lip (20%). Majority of our patients (77.3% [30]) were having Stage IV disease. Mandibulectomy was either segmental (62.5%) or marginal (37.5%). Bilateral neck dissection (37/40, 92.5%) was done in most patients. Among all patients, 62.5% (25) received adjuvant radiotherapy. The local recurrence rate after a median follow-up of 30 months was 15% (6). Two-year disease-free survival and overall survival were 89% and 90%, respectively.

Conclusion: Central arch of the mandible is a difficult disease to treat. It needs a complex and lengthy reconstructive procedure. Comorbidities such as extreme age, diabetes, and pulmonary and cardiac illnesses make it more challenging to manage. With the proper evaluation of comorbidities and avoiding long, cumbersome procedures, we can provide patients a fairly good chance of survival.

Keywords: Anterior arch; mandibulectomy; oral cancer; outcome; reconstruction.