End results of 114 extended "commando" operations for retromolar trigone carcinoma

Retromolar trigone carcinomas invade the mandible and the pterygoid and/or masseter muscles in a large number of cases. There is also a significant risk of ipsilateral lymph node neck metastasis. The purpose of this retrospective study was to report the survival results of 114 consecutive patients who underwent an extended "commando" operation (retromolar operation) from 1960 to 1991. The technique is a variation of a composite resection. The operation consists of hemimandibulectomy with resection of the pterygoid and masseter muscles, with an ipsilateral neck dissection (radical classical, modified, or supraomohyoid). The oral cavity and oropharyngeal defects were closed primarily in 83 patients. In the remaining 31 patients (27.2%), it was reconstructed by a tongue flap (12 patients), pectoralis major myocutaneous flap (10 patients), and other flaps (9 patients). There were 104 men and 10 women, with a median age of 55 years. All patients had squamous cell carcinoma. Tumor stages were T1 (5 patients), T2 (44 patients), T3 (24 patients), T4 (28 patients), and Tx (13 patients). The metastases were predominantly in levels I and II. Only patients with positive nodes at levels I and/or II had histologically positive nodes at levels IV or V. Complications occurred in 51.8% of the patients (wound infection in 21 patients, 18.4%). Sixty-six patients underwent postoperative irradiation (4 to 70 Gy, median: 50 Gy). To date, 41 patients have presented with 50 tumor recurrences: 31 local, 9 in the dissected neck, 3 in the contralateral neck, and 7 distant. The 5-year actuarial overall survival rate was 80.0% in patients with T1 tumors, 57.8% in those with T2 tumors, 46.5% in those with T3 tumors, and 65.2% in those with T4 tumors. In conclusion, the retromolar operation can be performed with acceptable morbidity, and it is effective (5-year overall survival rate of 55.3%). The rate of local recurrences (27.2%) suggests that radiotherapy as an adjunctive modality should be indicated in patients in whom recurrences are likely.