Removal of Cancer - Commando Surgery

Whether you consider the name nostalgic, appropriate, or even offensive, the term “Commando Surgery” evokes mental images of military battles and heroic soldiers. In its best light, commando surgery can be considered a heroic surgery and that the surgeon is waging a great battle with the evil of cancer. However the true hero in commando surgery is the patient that endures such an aggressive surgical procedure.

 

Loosely applied, commando surgery can be applied to any aggressive surgery that is used to remove cancerous tumors and metastatic cancerous tissue from the body. In the past, the phrase commando surgery was occasionally used interchangeably with “radical” as in radical mastectomy; however the actual tissue removed involved a commando operation is more extensive than what is covered in even a radical resection.

 

More precisely, commando surgery is the term applied to a particular procedure that includes the removal of cancer from the mouth or oral cavity. In fact, this is the most commonly accepted definition of the term. In this context, commando surgery involves the removal of the lower jaw bone (mandible), the floor of the mouth, usually part of the tongue, the front part of the neck, and the lymph nodes contained in these structures. One of the reasons that this surgery earned the moniker “commando surgery” is that these structures are removed as one large section, called en bloc.

 

 

Obviously such a drastic, aggressive surgery leaves the patient with several challenges after the commando procedure. Eating and drinking can be seriously affected and often food must be delivered in a pureed or liquid form directly to the stomach. If chewing is possible, the taste of food can no longer be sensed. There is also a huge cosmetic change associated with the commando surgery. This can be restored to a certain degree with reconstructive and cosmetic plastic surgery, but these procedures are not usually performed at the time of the commando surgery itself.

 

Head and neck cancer account for about 15 % of all cancers. Tobacco use, including smoking cigarettes and chewing snuff can increase the risk of these cancers. Alcohol has an additive effect when combined with tobacco. Significant daily smoking and drinking can increase the risk of oral cancer five times. Interestingly poor dental care, hygiene, and chronic dental disease can increase the risk of these cancers by eight times. Given the dramatic change in a person’s appearance and ability to eat and drink normally that occurs after commando surgery, it seems highly reasonable to avoid these risk factors by reducing or eliminating tobacco and alcohol and maintaining good dental hygiene and oral health.

 

Fortunately with improvements in chemotherapy, radiation therapy and imaging techniques, the number of commando surgeries has decreased considerably since the 1950s. Also since the commando operation leaves the patient with radical changes to the face and first part of the digestive system, attempts have been made to revise the surgery to preserve as much normal structure as possible. However in many countries surgery is still the first line therapy for oral cancer. Since the teeth and jaw bones are radiosensitive (they can be harmed by radiation treatment) surgery is actually the preferred option in many cases of oral cancer.