Surgery for cancer of the buccal mucosa

Buccal Mucosa cancer is common in India, T4 tumours being the most common (66%). T1 tumours are rarely seen (4%). Disease-free survival (DFS) at 18 mo with surgery alone for T2, T3, and T4 tumours is 57%, 43%, and 21%, respectively. Addition of postoperative radiation therapy (RT) for T3 and T4 lesions increases DFS to 60% and 35%, respectively. Marginal mandibulectomy is advocated for lesions close to the lower gingiva when the bone is clinically and radiologically uninvolved. The local control rate with marginal mandibulectomy is 79%. In T3/T4 tumours, results with supraomohyoid dissection are comparable to radical neck dissection when the upper jugular nodes are histologically negative. In T4 tumours, histological grading forms an important parameter for identification of a favourable subset. In well-differentiated tumours DFS was 48% with surgery and 72% with surgery and postoperative RT; in moderately differentiated tumours it was 12% and 21%, respectively; and in the poorly differentiated group there were no survivors.