In 1906, Geoge Crile first described the technique of radical neck dissection. The combined operation for the lesions of the month, including mandible & neck dissection "in-continuity" was developed and standardized by Dr. Hayes Martin at Memorial Hospital & Dr. Fr. G. E. ward at John Hopkins Hospital, in dividnally in the 1940s
The above mentioned terminology for the combined operation was abbreviated to Commando as a single ward at Memorial Hospital in 1942, the year of the allied Commando raids on Dieppe..
This operation remains the most effective procedure for the management of most primary intraoral tumors except very small lesions of the anterior 2/3 of the tongue, buccal mucosa, or floor of month.
This report is based upon 49 standard & modified Commandos at Presbyterian Medical Center Jeon ju between Jan. 1st 1961 & Dec. 31th, 1975.
An analysis of the patients who underwent Commando procedures reveals the followings: 1) Males outnumbered females by about 6 : 1
2) The average age at the time of surgery was 52. 1 years. The age range of most patients (88%) was from 4070 years.
3) The most common sites of origin of the primary cancers were tongue, floor of month, tonsil and gum in that order.
4) The overall ratio of smokers & non-smokers was 4.6: 1, the ratio of drinkers & non-drinkers was 3. 2: 1
5) The most frequent pathologic types were epidermoid carcinoma (42/49), adenocystic carcinoma and adenocarcinoma in that order.
6) The mean duration of symptoms before admission was 6. 1 months and there was no relationship between primary site of origin and pathologic type of duration of symptoms.
7) The chief complaint in most cases was ulceration painful mass which was aggravated by swallowing.
8) Analysis of the operative procedures employed reveals that the standard Commando was used in nearly half of all cases (44.9%).
9) In terms of reconstructive technique, a cervical or "nape" flap was used in nearly half of all cased, a forehead flap in 14% and a Bakamjian flap in 4%. No pedicle flaps were used in nearly 30% of cases.
10) Adjunctive radiation therapy was employed in 30% of all cases. The salvage rate was less than with surgery alone, largely due to the more frequent development of carotid artery rupture.
11) The main post operative complications were wound infection, Orocutaneous fistula and carotid artery blowout. Wound infection developed in 70% of all cases but most of the cases was minor and did not require special procedures to bring about healing. Orocutaneous fistula occurred in 34% of the cases. There were 6 cases of carated artery rup-ture within 5 months rost operatively: Four of these were in patients free from cancer.
12) The 5-year survival rate was 30.3% & the 3-year survival rate was 37.84%
There was no relationship between the salvage rate and the primary site of origin or pathologic type of lesion. Further evaluation of this result will be required. A close relationship between survival rate and T.N.M. staging system was demons-trated.
13) The mean duration of recurrence was 7.04 months and the mean duration of survival among patients who had recurrent disease was 16.4 months in Summary:
1) The Commando is the most effective method of dealing with intraoral cancer
2) The most dangerous postoperative complication is carotid artery blow out, which occurred most frequently in patients treated by preparative irradiation.
3) The T.N.M. staging system is the most important method for evaluation of prognosis
& Treatment.
4) The results may be farther improved by technical efforts to produce a wider margin around the primary tumor, to reduce the dangers of exfoliation of tumor cells into the wound at the time of operation, and to employ combined surgery with definitive post operative radiation.
5) Poorly planned efforts at treatment without accurate pathologic diagnosis & characterized by incomplete removal of gross disease not only fail to control intra-oral cancer but bring the added dangers of aggravating the growth of the tumor and its metastasis, of causing local infection and of delaying appropriate radical treatment.
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