The Composite Operation in Cancer of the Head and Neck (Commando Procedure)

During the last 16 years, 130 patients were treated with the radical composite operation (commando procedure) for extensive malignancies of the oropharyngeal cavity. All but two patients had invasive squamous cell carcinoma. The primary tumor was localized in the floor of the mouth in 37% of the patients, mandibular ridge and gingiva in 24%, and tongue in 18%. The operative mortality was 1.5%. The main complications were oro-cutaneous fistula and infection. The three-year survival was 38.6% and the five-year survival was 23%. Main reasons for failure were local recurrence noted in 43 patients and distant metastasis to organs of the chest and abdomen in 11 patients. Of interest was a second primary to the esophagus remote from the primary site seen in six patients.