Primary Oral Reconstructions with Microvascular Flaps in Patients with Oral Cancer in Advanced Stages, Impact on Survival and Quality of Life of Patients. Summary of the Doctoral Thesis

Abstract

Oral cancer is the most common type of cancer in the head neck area. Initially can be seen that mucosa is altered, swelling or a small ulcer are formed; tumor often early metastasizes in cervical lymph nodes. Oral flat squamous cell cancer is the fifth most commonly diagnosed cancer in men and the seventh in women with a predominance of more than 3% of malignancies. Worldwide, oral cancer is more and more associated with growth and aging of population. Due to the asymptomatic course of oral cancer for a long time, often a tumor is diagnosed in late stages. In Latvia, the incidence of oral cancer has increased by 16% over the past 10 years. In 2016, out of 200 patients who were found to have had oral cancer, in 132 patients it was diagnosed at an advanced stage. Tumor surgery is the corner stone of the treatment. An excision defect is easy to correct at an early stage of the tumor, but it becomes more difficult if oral cancer is at an advanced stage. These patients require excision of the tumor, extrusion of the cervical lymph nodes and oral reconstruction with flap. If no surgical treatment is performed, the radiotherapy with or without chemotherapy is an alternative. The aim of our study was to compare survival in patients undergoing surgical treatment with patients whose basic treatment was a radiation therapy. The effects of tumor size, degree of differentiation and localization on survival were analyzed. We analyzed the tumor association with tumor metastasis tendency to regional lymph nodes and lymph node involvement degree of impact on patient survival. For patients who used surgical treatment was performed post-operative complications analysis, as well as evaluation of the quality of life. The study included 185 patients with oral cancer advanced stage (III and IV), from which the surgery was carried out in 142 patients, and radiotherapy, as the main method of treatment was applied to 43 patients. Our Work led to the conclusion that the only method of treatment which provides a 5-year survival is a surgical treatment. None of the patients who received radiotherapy with or without chemotherapy did not live for 5 years. Conversely, in patients undergoing surgical treatment, 5-year survival rate was 42%.