Surgical therapy of oral cancer

Treatment of squamous cell carcinoma, 90% of oral cancers, is unimodal (surgery vs. radiotherapy) for small tumors, multimodal (surgery and radiotherapy or chemoradiotherapy) for big ones. If a patient undergoes surgical treatment for an oral cancer, this implies two equally important phases: the resection of the tumor and reconstruction of the operated region. The sole eradication of the tumor, though extremely important, cannot be considered the single goal of the treatment. Indeed, negative functional and esthetic outcomes of surgery, affecting negatively the quality of life of the patient must be avoided as much as possible. In order to achieve this result, it is fundamental to utilize surgical accesses that allow the safe and complete removal of the lesion, minimizing at the same time esthetic and functional impact. It is also necessary to reconstruct the amputated region to the best of actual possibilities. Modern surgery aims to restitutio ad integrum of operated regions. That is particularly important in tumor surgery of the maxillo-facial area, where mutilations may worsen patients' quality of life. All these concepts apply, excluding only rare exceptions, also in advanced cases, cases with poor prognosis, patients with suboptimal general conditions, older people independently to the residual life expectancy. On the contrary, if prognosis is unfavorable and life expectancy brief, residual time should be as livable as possible. Reconstructive microsurgery, widely spread during the last 20 years, led to the full implementation of this concept and to the accomplishment of surgical operations once not even conceivable.