The surgical dilemma of ‘functional inoperability’ in oral and oropharyngeal cancer: current consensus on operability with regard to functional results
- 8 April 2009
- journal article
- Published by Wiley in Clinical Otolaryngology
- Vol. 34 (2), 140-146
- https://doi.org/10.1111/j.1749-4486.2009.01884.x
Abstract
If surgical resection of a tumour results in an unacceptable loss of function, this is defined as 'functional inoperability'. The current survey aims to define the borders of functional inoperability in oral and oropharyngeal carcinoma and evaluate its current use by obtaining opinions from the experts in the field.A web base survey.Dutch head-neck surgeons and radiotherapists.Assessment of functional results after tumour resection in twenty-two statements and five cases.Response on the survey is 93% and the reactions are variable. Reactions vary slightly by the size of the clinic or discipline (radiation oncology versus head and neck surgery). There is agreement about the unacceptable function loss after total glossectomy. There is no absolute consensus about the functional outcome after certain surgical procedures, namely: bilateral maxillectomy, resection of a tonsil and resection of base of tongue carcinoma including removal of the vallecula and epiglottis, and total soft palate resection. Disagreement of operability is also observed for T3 and T4 base of tongue carcinomas based on case descriptions and Magnetic Resonance Images. Assessment of whether one hypoglossal nerve can be preserved is agreed to be a key factor for functional operability.The term functional inoperability appears to be clinically used by Dutch experts in the decision making process in advanced head and neck carcinomas. According to the experts who took part in the survey, primary total glossectomy or sacrificing both hypoglossal nerves is an operation that causes too much and therefore unacceptable function loss. In several case scenarios a consensus over operability could not be reached by the experts. The decision varies per physician, institute and patient. Functional inoperability is variable and difficult to determine, but it is clinically used and therefore important to bring under attention.Keywords
This publication has 14 references indexed in Scilit:
- Transoral Robotic SurgeryJAMA Otolaryngology–Head & Neck Surgery, 2007
- Phase II Trial of Chemoradiation for Organ Preservation in Resectable Stage III or IV Squamous Cell Carcinomas of the Larynx or Oropharynx: Results of Eastern Cooperative Oncology Group Study E2399Journal of Clinical Oncology, 2007
- The uncertainty of the surgical margin in the treatment of head and neck cancerOral Oncology, 2007
- Quality of life after surgical treatment for oral and oropharyngeal cancer: A prospective longitudinal assessment of patients reconstructed by a microvascular flapOral Oncology, 2007
- Imaging anatomy of the vestibular and visual systemsCurrent Opinion in Neurology, 2007
- Cine Magnetic Resonance Imaging with Single-Shot Fast Spin Echo for Evaluation of Dysphagia and AspirationDysphagia, 2006
- Intensive Chemoradiotherapy as a Primary Treatment for Organ Preservation in Patients With Advanced Cancer of the Head and NeckJAMA Otolaryngology–Head & Neck Surgery, 2004
- Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neckHead & Neck, 2004
- The Evaluation of Dysphagia Following Radical Surgery for Oral and Pharyngeal Carcinomas by Cine-Magnetic Resonance Imaging (Cine-MRI)Dysphagia, 2002
- Long-term Quality of Life After Treatment of Laryngeal CancerJAMA Otolaryngology–Head & Neck Surgery, 1998