Prise en charge des cancers primitifs des glandes submandibulaires
Year: 2013
Type: article
Study design: Observational Study
Abstract: Introduction :Les tumeurs malignes de la glande submandibulaire se caracterisent par une grande diversite histologique. de ce travail est de rapporter notre experience dans la prise en charge de ces tumeurs et de suggerer une attitude therapeutique apres revue de la litterature. Patients et methode : Il s’agit d’une etude retrospective a propos de 20 patients colliges sur 17 ans. La decision therapeutique etait prise au sein d’un comite multidisciplinaire. Les moyens therapeutiques etaient la chirurgie tumorale et ganglionnaire, la radiotherapie et la chimiotherapie. Les pieces operatoires ont ete adressees pour examen anatomopathologique extemporane et definitif. Une surveillance clinique et radiologique a ete realisee. Le recul moyen etait de 35 mois. Resultats : L’âge moyen etait de 60,75 ans. Le delai moyen de consultation etait de 6,15 mois. La tumefaction submandibulaire etait le motif de consultation chez tous les patients. Des adenopathies cervicales etaient notees chez 8 patients (40%). Seize patients avaient beneficie d’une tomodensitometrie cervicale et du massif facial et un autre d’une Irm. La radiographie du thorax montrait un aspect de lâcher de ballon chez un patient et une opacite mediastinale chez un autre. L’abstention chirurgicale avait ete decidee pour 2 patients. Les patients metastatiques ont ete operes uniquement dans un but diagnostique. Dix-huit patients (85%) ont eu une submandibulectomie, dont une elargie a la mandibule. Pour le geste ganglionnaire, 11 patients ont eu un curage selectif triangulaire et 3 un curage fonctionnel complet. Une radiotherapie postoperatoire a ete realisee chez 14 patients (70%). Une radiotherapie palliative isolee a ete realisee chez 2 patients. Une chimiotherapie palliative a ete indiquee chez les 2 patients presentant des metastases a distance lors du diagnostic, mais n’a ete administree que dans un cas. La remission complete etait notee dans 11 cas (55%). Un seul patient avait presente une poursuite evolutive. Une recidive loco-regionale avait ete decelee chez 2 patients. Deux patients avaient developpe secondairement des metastases a distance. Le taux de mortalite dans notre serie etait de 25%. Conclusion : Les cancers de la glande submandibulaire representent une pathologie peu frequente. Le diagnostic a grandement beneficie de l’apport de l’imagerie. La strategie therapeutique depend du stade tumoral au moment du diagnostic et de l’etat general du patient. Le pronostic de ces tumeurs reste toujours reserve, surtout pour les tumeurs de haut grade diagnostiquees a un stade avance. Mots cles : Tumeurs malignes, glandes submandibulaires, submandibulectomie, carcinome adenoide kystique, adenocarcinome. Objective : malignant tumors of the submandibular gland are characterized by a great histological diversity. The purpose of this study was to report our experience in the management of these tumors and suggest a therapeutic after review of the literature. Patients and methods : This is a retrospective study about 20 patients collected over 17 years. Therapeutic decision was taken within a multidisciplinary committee. Therapeutic means were tumor and nodal surgery, radiotherapy and chemotherapy. Surgical specimens were sent for final pathologic examination. Clinical and radiological monitoring was performed. The mean follow up was 35 months. Results : The mean age was 60.75 years. The average consultation was 6.15 months. Submandibular swelling was the reason for consultation in all patients. Cervical lymph nodes were noted in 8 patients (40%). Sixteen patients underwent a cervical CT scan and just one a cervical mrI. Chest radiography showed an aspect of balloon release in a patient and a mediastinal opacity in another case.The surgical abstention was decided in 2 patients. metastatic patients were operated only for diagnostic purposes. eighteen patients (85%) had a submandibulectomy. 11 patients had a selective lymphadenectomy and 3 patients had a full functional lymphadenectomy. Postoperative radiotherapy was performed in 14 patients (70%). Palliative radiotherapy was performed in 2 patients. Palliative chemotherapy was indicated in 2 cases with distant metastases, but was administered in one case. Complete remission was observed in 11 cases (55%). One patient had a further evolution. a locoregional recurrence was detected in 2 patients. Two patients developed secondary distant metastases. The mortality rate in our series was 25%. Conclusion : Cancers of the submandibular gland represent an uncommon disease. The diagnosis has benefited greatly from the contribution of imaging. The therapeutic strategy depends on the tumor stage at diagnosis and the patient's general condition. The prognosis of these tumors is still reserved, especially for high-grade tumors diagnosed at an advanced stage. Keyswords : malignant tumor, submandibular glands, submandibulectomy, adenoid cystic carcinoma, adenocarcinoma.
Authors: J. Marrakchi, Z Attia, Y Yassin, C Nassr, M. Ayadi, A May, S. Touati, Saïd Gritli
Language: French
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3613755