TISSUE-CONSERVING SURGERY FOR PROGNOSIS, TREATMENT AND FUNCTION PRESERVATION

Objectives: To describe an approach based on initial tissue-conserving surgery used to obtain histologically determined prognostic informati on that has therapeutic implications and the potential to enhance pres ervation of function. Study Design: Analysis of a group of patients wi th head and neck cancer treated initially with tissue-conserving surge ry based on Mohs' histographic sectioning and selected neck dissection to derive histologically determined prognostic information with thera peutic implications and preservation in function. Methods: This study is primarily based on an analysis of patients from January 1, 1989, th rough June 4, 1996 assigned to a protocol evaluating resection of oral cavity squamous cell cancer with margin control using Mohs' histograp hic technique and/or a group of patients with neck assessment of N0 on clinical examination who are undergoing supraomohyoid neck dissection s. Results: Thirty-three primary tumor resections were performed using the Mohs' technique, and 54% required two or more Mohs' sections befo re clear histologic margins were obtained following resection based on clinically determined negative margins. There were 44 patients who un derwent unilateral or bilateral supraomohyoid neck dissections, and 33 % had occult, histologically positive nodes. When compared with the di sease of the neck specimens, a preoperative computed tomography scan h ad a sensitivity of 25%, a specificity of 77%, and an accuracy of 63%. Conclusions: This report describes the effectiveness of Mohs' histogr aphic sectioning and selective neck dissection as a means of determini ng prognostic information that can be used to develop a focused and co st-effective treatment program that, along with contemporary reconstru ctive techniques, provides a potential enhancement of function preserv ation.