[Approach to the primary mass and neck in lower lip cancers: analysis of 24 cases]

In this study, we analyzed the surgical approach which we carried out for treatment of the primary mass and neck in 24 lower lip cancer cases and its results.

24 patients (5 females, 19 males; mean age 56.8; range 41 to 72 years) who were operated on in our clinic for lip cancer between March 1995 and March 2007 and whom we were able to long term follow-up were included in this study. Tumor was resected with 1-2 cm surgical margin in all cases. The tissue defect was reconstructed by either primary closure or local/regional flaps. If the tumor was located in the middle of the lip, bilateral neck dissection, otherwise unilateral neck dissection was performed. Postoperative radiotherapy was used in cases who had neck metastatic disease. Functional results were evaluated regarding recurrence and mortality rates during five-year mean follow-up period.

Tumor was originated from the lower lip alone in 20 cases. There was secondary commissure involvement in four cases. According to the TNM (tumor, node, metastasis) classification (AJCC, 2002), distribution of the cases was T1N0M0 (n=10), T2N0M0 (n=9), T3N1M0 (n=3), T4N2aM0 (n=1), T4N2cM0 (n=1). Primary closure (n=7), Abbe-Estlander flap (n=9), Karapandzic flap (n=4), Melolabial flap (n=3), Fan flap (n=1), pectoralis major myocutaneous flap (n=2) were used as reconstruction techniques. Histopathologically, metastatic disease was determined in the neck in four cases. During the follow-up period, there occurred ocal recurrence in two cases and regional metastasis in one. Two cases with distant metastasis died. Survival rates without illness for early and advanced stage tumors were 100% and 20%, respectively. Functional results after reconstruction were satisfactory, except in two cases which we used pectoralis major myocutaneous flap for reconstruction.

Five-years survival rates without illness were significantly lower in cases with advanced stage tumor and N positive neck. This result indicates that stage of the tumor and neck involvement have a significant effect on prognosis. Furthermore, more satisfactory functional results were achieved in early stage tumors.