Tongue cancer -restoring swallowing process

http://www.rso.ualberta.ca/news.cfm?story=55250
?Beavertail? surgery helps restore swallowing process

by Bev Betkowski

Drs. Hadi Seikaly and Dan O?Connell are making it easier for survivors of
tongue cancer to eat on their own.
(Jan 17, 2007) - Edmonton - A new surgical technique pioneered at the
University of Alberta has given back the ability to swallow to patients
with tongue cancer.

By modifying an existing technique of transplanting tissue from a
patient's forearm to his tongue, surgeons can provide enough bulk to help
improve the vital process of swallowing. The modification involves
including a 'jellyroll' of fat and connective tissue along with the tissue
and skin of the forearm to replace diseased tongue tissue that is removed
if a patient opts for surgical treatment of the cancer.

The surgery is then followed up with radiation or chemotherapy, but that
shrinks and scars the tongue, turning normally elastic and pliable tissue
to something like wood. This reduces the patient's ability to swallow to
the point that they must be fed through a tube placed through their skin
directly into the stomach, because they can't take enough food to maintain
their calorie requirements.

The so-called 'beavertail' modification adds more bulk to the tongue,
helping protect it from the effects of radiotherapy.

The study's findings support the position that the surgery is just as
effective as the standard treatment of combined chemotherapy and
radiotherapy, but the surgical technique also preserves the patient's
ability to swallow, said Dr. Dan O'Connell, lead author on the study and a
surgical resident in the U of A's Division of Otolarynology - head and
neck surgery.

"Other centres in Canada treat patients using radiotherapy and
chemotherapy alone, and it was thought that the results were as good or
better than what any surgery could do," O'Connell said. "But we found that
by adding that jellyroll of tissue, you give the tongue ability to
compensate for its lack of mobility."

The technique, developed by Drs. Hadi Seikaly and Jeff Harris, preserves
the patient's ability to swallow after treatment.

The study was conducted jointly by researchers in the U of A faculties of
Medicine and Dentistry, Rehabilitation Medicine as well as the
Misericordia Hospital. O'Connell presented their findings at the
international meeting of the annual American Head and Neck Society in
Chicago earlier this year, where the study won the title of Best Resident
Clinical Research Award.

The beavertail modification meant that 95 per cent of the 20 patients who
completed the study (there were 36 originally) were able to swallow
successfully after one year of tongue reconstruction. Only one patient
still had problems with swallowing.

The surgery involves removing the cancerous tissue and replacing it with a
healthy paddle of skin and connective tissue with artery intact, and
connecting it to healthy blood vessels in the neck. The beavertail of fat
that comes with the skin is connected to the base of the tongue to add
bulk, and rolled upon itself, much like a jellyroll. The tongue is crucial
to the swallowing process; the base of a healthy tongue acts as a piston
that pushes food down the throat. With surgery, the reconstructed tongue
instead acts as a buttress, which squeezes the food into the esophagus.

There are about 900 cases of cancer of the base of tongue or tonsils
diagnosed in Canada each year, and while that accounts for just one per
cent of all cancers in North America, doctors are seeing a disturbing
trend. The cancer is attributed to smoking and alcohol consumption, but
the fastest-growing group of new cases involves people who don't have
those risk factors. "It's not an epidemic, but it is scary when you
realize you can do everything right and still be saddled with this
condition," O'Connell said.

The research team hopes the study's findings will convince other doctors
treating patients with base of tongue cancers that primary surgery
followed by radiation gives them the best chance at swallowing after their
treatment.


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