This clinico-statistical study concerns 327 cases of squamous cell carcinoma (SCC) arising from the oral mucosa in the Department of Oral and Maxillof acial Surgery at Kyoto University hospital during the decade from 1990 to 2000. Radical treatment was performed on 286 of these cases.
Our treatment strategy for oral SCC consisted of adequate excision as our first choice for early-stage lesions (T1, early T2), and of combination therapy combining preoperative radiation and surgery for advanced cancers (T3, T4) . In principle, prophylactic neck dissection for early-stage cases and systemic chemotherapy has not been used. The 5-year survival rate was 74.1% overall and 84.3% for the radical treatment group.
The 5-year survival rate was analyzed for the radical treatment group according to stage and primary site classification. The results were as follows, with the number of cases shown in parentheses. Stage I (58) : 98.3%, Stage II (90) : 86.1 %, Stage III (58) : 88.4 %, and Stage IV (80) : 66.6 %; tongue (121) : 84.9 %, lower alveolus and gingiva (60) : 82.6 %, buccal mucosa (42) : 75.5 %, upper alveolus and gingiva (34) : 83.2 %, and floor of the mouth (29) : 92.2 %.
The 40 tumor-related deaths were caused by 11 primary lesions, six cervical metastases, 16 distant metastases, four metastases to the peripheral pharyngeal lymphnodes, two postoperative course, and one course of chemotherapy.

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Systemic inflammatory response syndrome (SIRS) symptoms immediately after surgery have lately been regarded as potential warnings of impending postoperative complications and multiple organ failure. Reports discussing the relationship between operative stress and SIRS are found in the filed of digestive surgery, but not in that of oral surgery. Fifty-five oral cancer cases who had undergone neck dissection (Level III or higher) from January 1998 to December 2001 were involved in this study. We assigned 25 cases who met two of the several diagnostic criteria for SIRS and continued to meet them for at least 24 hours after surgery to the SIRS group. The other 30patients were assigned to the non-SIRS group. Postoperative complications occurred in 56.0% of the SIRS group and 6.7% of the non-SIRS group (p<0.05) . In six cases, the postoperative fluctuation of IL-6 level was evaluated. These results suggest the importance of careful management of postoperative SIRS patients to prevent complications.

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Oral epithelial dysplasia is the diagnostic term used to describe the histopathological changes seen premalignant disorders of the oral mucosa. However, the diagnosis and evaluation of epithelial dysplasia in the oral mucosa is performed by several criterias. The epitelial dysplasia on surgical margin was examined pathologically in 50 patients with squamous cell carcinoma of the tongue who underwent surgical treatment from 1995 to 1998, by several criterias, and evaluated relationship between several criterias and postoperative local recurrence.
1. The occurrence of epithelial dysplasia according to criteria of Burkhardt et al (1981) was higher than criteria of WHO (1997) and Uterin cervical cancer (1997) .
2. The rate of local recurrence was more than 80% in patients with moderate and severe epithelial dysplasia by each criteria. However, there was no difference between the incidence and grade of epithelial dysplasia, and each criteria.
3. Our results suggest that the criteria of WHO (1997) is a reliable and useful method for diagnosing epithelial dysplasia in oral mucosa.

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Recently, multiple occurrences of malignant tumors in the same patients are increasing because of a longer life span, and a high cure rate of the first cancers.
During the 25 years, we have encountered 3 cases of oral cancer patients suffering from additional lesions in the oral cavity more than 10 years after the treatment of their first cancers. All of the first and second lesions in the 3 cases we studied were diagnosed as squamous cell carcinomas.
The first case was a 60-year-old woman. She suffered from tongue cancer on the right side, and the lesion was treated with radiotherapy. The second lesion, which occurred on the right side of the maxilla, was found after. 13 years, and it was surgically resected.
The second case was 52-year-old man. He suffered from a cancer on the right side of the oropharynx, which was treated with radiotherapy. The second lesion occurred on the left side of the tongue after 12 years. The tumor was radically resected.
The third case was a 51-year-old woman. She suffered from cancer of the left side of the mouth floor, and the lesion was resected with upper neck dissection. The second lesion occurred on the right side of the tongue after 12 years. The tumor was radically resected. The third lesion was found on the left side of the oropharynx 2 years after treatment of the second lesion, and it was treated with radiotherapy.
The second patient died of a cirrhotic liver, but the other two patients are tumor-free after final treatment for the second or third lesions.

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