73 Years Old Patient Successfully Undergoes Rare Side Lying Surgery for Stage III Oral Cancer at Kailash Hospital

Treating oral cancer in elderly patients is often challenging, particularly when serious underlying medical conditions coexist. While advanced age alone should never prevent curative treatment, severe comorbidities can make surgery technically demanding and significantly increase perioperative risks. At Kailash Hospital, Noida, a 73-year-old male patient with Stage III cancer of the floor of the mouth, severe Chronic Obstructive Pulmonary Disease (COPD), and marked spinal deformity underwent a highly complex and rare surgical procedure under the expert care of Dr. Manish Sahni, Consultant Surgical Oncologist. This case demonstrates how meticulous planning, multidisciplinary collaboration, and innovative surgical techniques can make curative treatment possible even in extremely high-risk patients.

Presentation of Symptoms (if any)

The patient presented with:

• Difficulty in tongue movement
• A gradually enlarging lump beneath the tongue
• Difficulty while eating and speaking

He also had significant pre-existing medical conditions, including severe COPD requiring multiple inhalers and nebulization, along with longstanding kyphoscoliosis that prevented him from lying flat comfortably.

Diagnosis

Following detailed clinical examination and diagnostic investigations, the patient was diagnosed with Stage III carcinoma of the floor of the mouth.

Comprehensive preoperative assessment also revealed:

• Severe Chronic Obstructive Pulmonary Disease (COPD)
• Significant kyphoscoliosis (spinal deformity)
• High anesthetic and surgical risk because of impaired respiratory function and inability to assume the conventional surgical position.

A multidisciplinary evaluation confirmed that although the cancer was operable, the patient’s associated medical conditions required a highly customized surgical strategy.

Condition Overview

Cancer of the floor of the mouth is one of the common forms of oral cancer, particularly among individuals with a history of long-term tobacco use. Early surgical removal offers the best chance of cure.

What made this case exceptionally rare and clinically challenging was not only the patient’s advanced age but the coexistence of two major comorbidities:

• Severe COPD, increasing the risk of anesthesia, ventilation, and postoperative respiratory complications.
• Severe kyphoscoliosis, which prevented the patient from lying in the standard supine position required for oral cancer surgery.

Because conventional positioning was impossible, the surgical team had to completely modify the operative approach. Instead of performing the procedure in the traditional supine position, the surgery was carried out in a rare lateral (side-lying) position. Such positioning is very uncommon in major oral cancer surgeries and requires exceptional coordination between surgical oncology, anesthesia, and critical care teams.

Treatment Plan

After careful optimization of the patient’s respiratory condition and overall medical fitness, a multidisciplinary treatment plan was developed.

The management included:

• Comprehensive Preoperative Optimization
  • Respiratory stabilization using inhalers and nebulization
  • Detailed anesthetic evaluation considering severe COPD
  • Careful planning for airway management
• Customized Surgical Planning
  • Modification of conventional operating techniques because the patient could not lie flat
  • Planning of a rare side-lying (lateral) operative position to provide safe surgical access
• Complex Oral Cancer Surgery
  • A nearly six-hour operation performed by Dr. Manish Sahni
  • Continuous coordination between Surgical Oncology, Anaesthesia, and Critical Care teams
  • Specialized airway management throughout the procedure to ensure patient safety
• Postoperative Critical Care
  • Intensive monitoring following surgery
  • Respiratory support and pain management
  • Early rehabilitation with continuous multidisciplinary supervision

Outcome and Follow-Up

Despite the complexity of the procedure and the patient’s multiple comorbidities, the surgery was completed successfully without major complications.

The patient demonstrated an excellent postoperative recovery. His respiratory condition remained stable, healing progressed satisfactorily, and he gradually resumed oral intake and daily activities. He was discharged approximately five to six days after surgery with advice for regular oncological follow-up and continued monitoring.

The patient expressed immense relief after successful treatment, sharing that although the diagnosis had initially caused great concern because of his age and other illnesses, he was now free from the symptoms that had affected his quality of life.

Conclusion

This case represents an outstanding example of personalized cancer care and multidisciplinary surgical excellence. Successfully treating Stage III oral cancer in a 73-year-old patient with severe COPD and kyphoscoliosis required innovative thinking, meticulous planning, and exceptional teamwork.

The use of a rare side-lying surgical approach, adapted specifically to overcome the patient’s spinal deformity, demonstrates how individualized surgical techniques can make curative treatment possible even in the most complex situations. It also reinforces the importance of early evaluation of oral lesions, particularly among chronic tobacco users, where timely diagnosis and expert surgical management can significantly improve outcomes. This remarkable case reflects the advanced capabilities of Kailash Hospital, Noida, in managing high-risk oncological patients through comprehensive, patient-centered care.

Media References

• Times Now
• Inshorts
• MSN
• Dailyhunt