Oral Cancer Surgery (Commando) - Procedure, Cost in India, Risks, Recovery and benefits

What is Oral Cancer Surgery (Commando)? 

Oral Cancer Surgery, often referred to in clinical settings as Composite Resection with Mandibulectomy and Neck Dissection, is a comprehensive surgical approach used to treat oral cancers, particularly those affecting the tongue, floor of mouth, buccal mucosa, and jaw. The term Commando—a colloquial acronym derived from Composite resection + Mandibular resection + neck Dissection—reflects the multi-component nature of the procedure. 

This surgery aims to remove the primary tumor along with a portion of the mandible (jawbone) and associated lymph nodes in the neck, ensuring complete excision of cancerous tissue. Reconstruction may follow using tissue grafts or flaps to restore oral function and facial aesthetics.

The primary goal of this procedure is to achieve local control of the disease by removing all visible and microscopic cancer, thereby reducing the risk of recurrence and metastasis. This surgery is most commonly indicated for patients with oral squamous cell carcinoma (OSCC), the most prevalent form of oral cancer.

Why is Oral Cancer Surgery (Commando) Done?

Oral Cancer Surgery (Commando) is typically recommended for patients who exhibit symptoms or conditions indicative of oral cancer. Common symptoms that may lead to the recommendation of this procedure include: 
 

1. Persistent sores or ulcers in the mouth that do not heal 
2. Unexplained lumps or swelling in the neck or oral cavity 
3. Difficulty swallowing or chewing 
4. Changes in voice or speech 
5. Unexplained weight loss 
6. Oral pain that does not respond to standard pain relief methods

These symptoms can be alarming and may prompt further investigation through diagnostic imaging and biopsies. If these tests confirm the presence of cancer, particularly in advanced stages, Oral Cancer Surgery (Commando) becomes a critical option for treatment. 
 
The procedure is typically recommended when the cancer is localized and has not spread extensively to other parts of the body. Early detection is key, as it significantly increases the chances of successful treatment and recovery. In some cases, the surgery may also be indicated for patients with precancerous lesions, where the risk of developing cancer is high.

Indications for Oral Cancer Surgery (Commando)

Several clinical situations and diagnostic findings can indicate that a patient is a suitable candidate for Oral Cancer Surgery (Commando). These include:

1. Diagnosis of Oral Cancer: A confirmed diagnosis of oral squamous cell carcinoma or other types of oral malignancies is the primary indication for this surgery. This diagnosis is typically made through a combination of physical examinations, imaging studies (such as CT or MRI scans), and biopsy results.
2. Tumor Size and Location: The size and location of the tumor play a significant role in determining candidacy for the procedure. Tumors that are localized and have not invaded critical structures (like major blood vessels or nerves) are more likely to be treated effectively with surgery.
3. Tumor Staging (TNM Classification): The TNM staging system—which evaluates Tumor size (T), regional lymph Node involvement (N), and distant Metastasis (M)—plays a critical role in surgical planning. Commando surgery is often considered for T2–T4 tumors, especially when there is N1–N3 lymph node involvement but no distant metastasis (M0).
4. Lymph Node Involvement: If imaging studies reveal that cancer has spread to nearby lymph nodes, the surgery may involve a neck dissection to remove these nodes along with the primary tumor. This is crucial for preventing further metastasis.
5. Patient Health Status: The overall health of the patient is also a critical factor. Candidates for Oral Cancer Surgery (Commando) should be in good health to withstand the surgical procedure and subsequent recovery. Pre-existing conditions, such as heart disease or diabetes, may complicate the surgery and recovery process.
6. Response to Other Treatments: In some cases, if a patient has undergone radiation or chemotherapy and the tumor has not responded adequately, surgery may be recommended as a next step to control the disease.
7. Presence of Precancerous Lesions: Patients with dysplastic lesions or other precancerous conditions may also be considered for surgery to prevent the progression to cancer.

While the procedure can be highly beneficial, it may not be suitable for everyone. The decision to proceed with Oral Cancer Surgery (Commando) is based on a comprehensive evaluation of the patient's condition, the characteristics of the tumor, and the potential benefits of surgical intervention. It is essential for patients to discuss their individual circumstances with their healthcare team to understand the best course of action for their specific situation.

Contraindications for Oral Cancer Surgery (Commando)

While Oral Cancer Surgery (Commando) can be a life-saving procedure for many patients, certain conditions or factors may render a patient unsuitable for this type of surgery. Understanding these contraindications is crucial for both patients and healthcare providers to ensure the best possible outcomes.

1. Advanced Age: Older patients may have a higher risk of complications due to age-related health issues. If a patient has significant comorbidities, such as heart disease or respiratory problems, the risks associated with surgery may outweigh the benefits.
2. Poor Overall Health: Patients with severe systemic diseases, such as uncontrolled diabetes, liver disease, or kidney failure, may not tolerate the stress of surgery well. A thorough evaluation of a patient’s overall health is essential before proceeding.
3. Active Infections: If a patient has an active infection, particularly in the oral cavity or surrounding areas, surgery may be postponed until the infection is resolved. This is to prevent further complications and ensure a safer surgical environment.
4. Blood Disorders: Conditions that affect blood clotting, such as hemophilia or thrombocytopenia, can increase the risk of excessive bleeding during and after surgery. Patients with these disorders may require special considerations or alternative treatment options.
5. Smoking and Alcohol Use: Patients who smoke heavily or consume excessive alcohol may face increased risks of complications, including poor wound healing and higher rates of infection. Smoking cessation and reducing alcohol intake are often recommended before surgery.
6. Unrealistic Expectations: Patients who have unrealistic expectations about the outcomes of surgery may not be suitable candidates. It’s important for patients to have a clear understanding of what the surgery can achieve and the potential for changes in appearance or function.
7. Psychological Factors: Patients with significant psychological issues, such as severe anxiety or depression, may not be in the best state of mind to undergo surgery. A psychological evaluation may be necessary to determine readiness for the procedure.
8. Previous Radiation Therapy: Patients who have undergone radiation therapy to the head and neck region may have compromised tissue integrity, making surgery more complex and risky. A careful assessment of the surgical site is essential in these cases.
9. Nutritional Deficiencies: Malnutrition can significantly impact healing and recovery. Patients with nutritional deficiencies may need to undergo nutritional support before being considered for surgery. 
10. Inability to Follow Post-Operative Care: Successful recovery from Oral Cancer Surgery (Commando) requires adherence to post-operative care instructions. Patients who may struggle to follow these guidelines may not be suitable candidates for surgery.

How to Prepare for Oral Cancer Surgery (Commando)

Preparing for Oral Cancer Surgery (Commando) involves several important steps to ensure that patients are ready for the procedure and can achieve the best possible outcomes. Here’s a guide to help you understand what to expect during the preparation phase.

1. Consultation with Your Healthcare Team: Before the surgery, patients will have a detailed consultation with their surgical team. This is the time to discuss any concerns, ask questions, and understand the procedure thoroughly.
2. Medical Evaluation: A comprehensive medical evaluation will be conducted, including a review of the patient’s medical history, current medications, and any existing health conditions. This may involve blood tests, imaging studies, and other diagnostic tests to assess overall health.
3. Pre-Operative Instructions: Patients will receive specific instructions on how to prepare for surgery. This may include dietary restrictions, such as fasting for a certain period before the procedure, and guidelines on medication management.
4. Medication Adjustments: Patients may need to adjust or stop certain medications before surgery, especially blood thinners or medications that can affect healing. It’s essential to follow the healthcare provider’s instructions regarding medication use.
5. Smoking Cessation: If the patient is a smoker, they will be encouraged to quit smoking well in advance of the surgery. Smoking can impair healing and increase the risk of complications.
6. Nutritional Support: Ensuring proper nutrition is vital for recovery. Patients may be advised to follow a balanced diet or even consult a nutritionist to optimize their nutritional status before surgery.
7. Emotional Preparation: Surgery can be an emotional experience. Patients should take time to mentally prepare for the procedure, which may include discussing feelings with family, friends, or a mental health professional.
8. Arranging Post-Operative Care: Patients should plan for post-operative care, including arranging for someone to drive them home after the surgery and help them during the initial recovery period.
9. Understanding the Procedure: Patients should familiarize themselves with what to expect during the surgery, including the anesthesia process, the duration of the procedure, and the expected recovery timeline. 
10. Follow-Up Appointments: Patients should schedule follow-up appointments with their healthcare team to monitor recovery and address any concerns that may arise after surgery.

Oral Cancer Surgery (Commando): Step-by-Step Procedure

Understanding the step-by-step process of Oral Cancer Surgery (Commando) can help alleviate anxiety and prepare patients for what to expect. Here’s a breakdown of the procedure from start to finish.

1. Pre-Operative Preparation: On the day of surgery, patients will arrive at the surgical facility, where they will check in and complete any necessary paperwork. A nurse will review the patient’s medical history and confirm the procedure.
2. Anesthesia Administration: Before the surgery begins, the patient will receive anesthesia. This may be general anesthesia, which puts the patient to sleep, or local anesthesia, which numbs the surgical area. The anesthesiologist will monitor the patient’s vital signs throughout the procedure.
3. Surgical Site Preparation: The surgical team will prepare the area where the surgery will take place. This includes cleaning the site and draping the patient to maintain a sterile environment.
4. Incision and Tumor Removal: The surgeon will make an incision in the oral cavity to access the tumor. The extent of the incision will depend on the size and location of the cancer. The surgeon will carefully remove the tumor along with a margin of healthy tissue to ensure complete excision.
5. Lymph Node Dissection: In many cases, nearby lymph nodes may also be removed to check for cancer spread. This is an important step in determining the stage of cancer and planning further treatment if necessary.
6. Reconstruction: After the tumor and any affected lymph nodes are removed, the surgeon may perform reconstruction of the oral cavity. This can involve using tissue from other parts of the body to restore function and appearance.
7. Closure of Incision: Once the surgery is complete, the surgeon will close the incision using sutures or staples. The surgical team will ensure that the area is clean and properly dressed.
8. Post-Operative Recovery: After the procedure, patients will be moved to a recovery area where they will be monitored as they wake up from anesthesia. Vital signs will be checked regularly, and pain management will be initiated.
9. Hospital Stay: Depending on the extent of the surgery, patients may need to stay in the hospital for a few days for monitoring and recovery. During this time, healthcare providers will provide instructions on pain management, nutrition, and oral care. 
10. Discharge and Follow-Up: Once the patient is stable and able to manage their pain, they will be discharged with specific post-operative care instructions. Follow-up appointments will be scheduled to monitor healing and discuss any further treatment options.

Risks and Complications of Oral Cancer Surgery (Commando)

Like any surgical procedure, Oral Cancer Surgery (Commando) carries certain risks and potential complications. While many patients undergo the procedure without issues, it’s important to be aware of both common and rare risks.

1. Common Risks:
   1. Bleeding: Some bleeding is expected after surgery, but excessive bleeding may require additional intervention.
   2. Infection: The surgical site may become infected, necessitating antibiotics or further treatment.
   3. Pain and Discomfort: Post-operative pain is common, but it can usually be managed with medication.
   4. Swelling and Bruising: Patients may experience swelling and bruising in the surgical area, which typically resolves over time.
   5. Difficulty Swallowing: Temporary difficulty swallowing may occur as the surgical site heals.
2. Rare Risks
   1. Nerve Damage: There is a risk of nerve damage during surgery, which can lead to numbness or changes in sensation in the mouth or face.
   2. Changes in Speech: Some patients may experience changes in speech patterns following surgery, particularly if the tongue or other speech-related structures are affected.
   3. Anesthesia Complications: Although rare, complications related to anesthesia can occur, including allergic reactions or respiratory issues.
   4. Wound Healing Issues: Some patients may experience delayed healing or complications related to the surgical site, which may require additional treatment.
   5. Recurrence of Cancer: There is always a risk that cancer may return after surgery, necessitating further treatment or monitoring.

Understanding these risks can help patients make informed decisions about their treatment options and prepare for the recovery process. It’s essential to discuss any concerns with the healthcare team to ensure a comprehensive understanding of the procedure and its potential outcomes. 

Recovery After Oral Cancer Surgery (Commando)

Recovery from oral cancer surgery, particularly the Commando procedure, is a critical phase that requires careful attention and adherence to medical advice. The expected recovery timeline can vary based on individual health, the extent of the surgery, and any additional treatments like radiation or chemotherapy. Generally, patients can expect the following recovery stages:

1. Immediate Post-Operative Phase (0-2 Days): After surgery, patients are typically monitored in a recovery room. Pain management is a priority, and intravenous fluids may be administered. Patients may experience swelling, bruising, and discomfort in the surgical area.
2. Short-Term Recovery (3-7 Days): Most patients are discharged within a few days post-surgery. During this time, it’s essential to follow a soft diet to avoid irritation to the surgical site. Pain medication will be prescribed, and patients should rest as much as possible. Follow-up appointments will be scheduled to monitor healing.
3. Mid-Term Recovery (1-4 Weeks): Swelling and discomfort should gradually decrease. Patients can start to introduce more solid foods as tolerated. Regular follow-ups with the healthcare team are crucial to ensure proper healing and to address any complications.
4. Long-Term Recovery (1-3 Months): Full recovery can take several weeks to months. Patients may need speech therapy or dietary counseling to adjust to changes in oral function. Regular check-ups will continue to monitor for any signs of recurrence.

Aftercare Tips:

1. Maintain good oral hygiene to prevent infections. 
2. Follow a prescribed diet, starting with soft foods and gradually reintroducing solids. 
3. Stay hydrated and avoid alcohol and tobacco. 
4. Attend all follow-up appointments for monitoring and support.
5. Engage in light activities as tolerated, but avoid strenuous exercise until cleared by your doctor.

When Normal Activities Can Resume: 

Most patients can return to light daily activities within a week, but full return to work and normal routines may take several weeks, depending on individual recovery progress and the nature of their job. 
 

Benefits of Oral Cancer Surgery (Commando)

The Commando procedure offers several key health improvements and quality-of-life outcomes for patients diagnosed with oral cancer:

1. Tumor Removal: The primary benefit is the complete removal of cancerous tissue, which is crucial for preventing the spread of cancer and improving survival rates.
2. Improved Oral Function: While the surgery may initially affect speech and swallowing, many patients experience significant improvements in these areas after recovery, especially with the help of rehabilitation therapies. 
3. Enhanced Quality of Life: Successful surgery can lead to a reduction in cancer-related symptoms, such as pain and difficulty eating, allowing patients to enjoy a better quality of life.
4. Psychological Benefits: The removal of cancer can alleviate anxiety and fear associated with the disease, leading to improved mental health and emotional well-being. 
5. Potential for Reconstruction: In some cases, reconstructive surgery can be performed simultaneously or in subsequent procedures, helping restore the appearance and function of the mouth and face.

Oral Cancer Surgery (Commando) vs. Radiation Therapy

While the Commando procedure is a surgical intervention, radiation therapy is a non-invasive treatment option often used for oral cancer. Here’s a comparison of the two: 

Cost of Oral Cancer Surgery (Commando) in India:

The average cost ranges from ₹1,50,000 to ₹3,00,000.

Price can vary based on several key factors:

1. Hospital: Different hospitals have varying pricing structures. Renowned institutions like Apollo Hospitals may offer comprehensive care and advanced facilities, which can influence the overall cost. 
2. Location: The city and region where the Oral Cancer Surgery (Commando) is performed can affect costs due to differences in living expenses and healthcare pricing. 
3. Room Type: The choice of accommodation (general ward, semi-private, private, etc.) can significantly impact the total cost. 
4. Complications: Any complications during or after the procedure can lead to additional expenses.

At Apollo Hospitals, we prioritize transparent communication and personalized care plans. Apollo Hospitals is the best hospital for Oral Cancer Surgery (Commando) in India because of our trusted expertise, advanced infrastructure, and consistent focus on patient outcomes. We encourage prospective patients seeking a Oral Cancer Surgery (Commando) in India to contact us directly for detailed information about the procedure cost and assistance with financial planning.

With Apollo Hospitals, you get access to:

1. Trusted medical expertise
2. Comprehensive aftercare services 
3. Excellent value and quality care 

This makes Apollo Hospitals a preferred choice for Oral Cancer Surgery (Commando) in India. 

FAQs About Oral Cancer Surgery (Commando)

1. What should I eat before surgery? 
    In the days leading up to surgery, it's important to follow a nutrient-rich, balanced diet that supports healing and strengthens your immune system. Focus on soft, easy-to-chew foods like smoothies, soups, yogurt, mashed vegetables, and well-cooked cereals. Your doctor may advise you to avoid hard, spicy, or acidic foods that could irritate your oral tissues. On the day of surgery, you may be required to fast for several hours — your healthcare team will give you specific instructions.
2. How long will I be in the hospital after surgery? 
    Most patients stay in the hospital for about 2 to 5 days, depending on how extensive the surgery was and how well they recover in the initial phase. During this time, the medical team will monitor your pain levels, nutritional intake, wound healing, and general well-being. If reconstruction or flap surgery was involved, the stay may be slightly longer.
3. Can I eat solid foods right after surgery? 
   No, solid foods are usually not recommended immediately after surgery. You will start with a liquid or soft diet to prevent strain on the surgical site and allow proper healing. Foods like broths, pureed fruits, mashed potatoes, and nutritional supplements may be suggested. As your healing progresses, your care team will guide you in gradually reintroducing solid foods.
4. What pain management options are available? 
   Pain is a natural part of the recovery process, but your doctor will ensure it’s well-managed. You may be prescribed oral or intravenous medications like opioids, NSAIDs (e.g., ibuprofen), or acetaminophen. In some cases, nerve blocks or local anesthetics may also be used. Always follow the dosing schedule provided, and let your doctor know if your pain isn’t well-controlled.
5. How can I care for my mouth after surgery? 
    Post-operative oral care is vital to prevent infection and promote healing. You’ll be advised to:
   1. Gently rinse with a saltwater solution or antiseptic mouthwash (as prescribed).
   2. Avoid brushing near the surgical site until cleared by your doctor.
   3. Refrain from using alcohol-based mouthwashes or tobacco products.
   4. Stay hydrated and maintain good nutrition to support tissue repair.
6. When can I return to work? 
   The timeline for returning to work varies. Most patients can resume light activities within a week, but full return to work may take several weeks. Consult your doctor for personalized advice.
7. Will I need speech therapy after surgery? 
   Many patients benefit from speech therapy post-surgery, especially if there are changes in speech or swallowing. Your healthcare team will assess your needs and refer you to a specialist if necessary.
8. What are the signs of infection I should watch for?
   1. Be vigilant for:
      1. Increased pain, redness, or swelling at the surgical site
      2. Fever or chills
      3. Pus or foul-smelling discharge
      4. Difficulty opening the mouth or worsening discomfort.  
         If you notice any of these signs, contact your doctor immediately. Early treatment of infections prevents complications.
9. Can I drive after surgery? 
   It’s advisable to avoid driving for at least a week post-surgery or until you are no longer taking strong pain medications. Always consult your doctor before resuming driving.
10. What if I have difficulty swallowing after surgery? 
    Difficulty swallowing is common after oral cancer surgery. Work with your healthcare team to develop a plan that may include dietary modifications and swallowing exercises.
11. Is it safe to exercise after surgery? 
    Light activities can usually be resumed within a week, but avoid strenuous exercise until cleared by your doctor. Listen to your body and prioritize rest during recovery.
12. How often will I need follow-up appointments? 
    Follow-up appointments are typically scheduled every few weeks initially, then less frequently as you heal. Your doctor will determine the best schedule based on your recovery.
13. What should I do if I experience excessive bleeding? 
    If you notice excessive bleeding from the surgical site, apply gentle pressure with a clean cloth and contact your healthcare provider immediately for further instructions.
14. Can I smoke after surgery? 
     No. Smoking delays healing, increases infection risk, and significantly raises the chances of cancer recurrence. If you're a smoker, this is an important time to quit. Your healthcare team can help you find support programs.
15. What are the long-term effects of the Commando procedure? 
    Long-term effects can include changes in speech, swallowing, and appearance. Many patients adapt over time, and rehabilitation services can help improve function and quality of life.
16. Will I need additional treatments after surgery? 
    Depending on the pathology results, additional treatments like radiation or chemotherapy may be recommended. Your oncologist will discuss the best plan for your situation.
17. How can I manage anxiety before surgery? 
    Managing anxiety can include deep breathing exercises, talking to a counselor, or discussing your concerns with your healthcare team. They can provide support and reassurance.
18. What should I do if I have a cold or infection before surgery? 
    Inform your healthcare provider immediately if you develop a cold or infection before surgery. They may need to reschedule your procedure to ensure your safety.
19. Are there any dietary restrictions after surgery? 
    Initially, you will need to follow a soft diet. Avoid spicy, acidic, or hard foods that can irritate the surgical site. Your doctor will provide specific dietary guidelines.
20. How can I support my recovery at home?  Follow all care instructions given at discharge.