Enbloc resection of primary oral cancer involving infratemporal fossa: A systematic “out to in and top to bottom” surgical approach and outcomes

Abstract

Purpose: The oral cavity Squamous Cell Carcinoma (OCSCC) involving infratemporal fossa (ITF) is considered as cT4b stage per AJCC 8th classification. The treatment of these group of patients is challenging due to the difficulty in achieving negative resection margin status. In this study we have highlighted our surgical technique with oncological outcome of enbloc resection of primary oral cancer involving ITF. Methodology: This was a single centre retrospective study which included only patients with OCSCC extending into ITF. Our surgical technique of systematic “out to in and top to bottom” approach was detailed. The perioperative outcomes, histopathological details, survival outcomes were measured. Results: Over the period of 1 year a total of 340 patients with OCSCC reported to our outpatient department, out of which 120 patients belonged to cT4 category and 32 patients were cT4b stage with involvement of ITF. Amongst 32 patients, 2 patients had distant metastasis and were excluded from the study. The 5 patients received neoadjuvant chemotherapy followed by surgery and rest all patients were taken up for upfront curative surgery. There were no significant intraoperative and postoperative complications. None of the margins were found to be involved or close in the final histopathology report. The median DFS and OS were 31 months and 27 months respectively at a median follow up of 29 months. Conclusion: Our systematic approach of enbloc resection of primary oral cancer involving ITF is safe and easily reproducible with high rate of negative resection margin status.

Antiapoptotic PON2 expression and its clinical implications in locally advanced oral squamous cell carcinoma

“…The occurrence of OSCC varies across diverse populations, influenced by lifestyle factors, cultural practices, and health‐care accessibility 28 . Survival outcomes in locally advanced OSCC hinge on factors such as the extent of the disease at diagnosis, efficacy of treatments (comprising surgery, radiation therapy, and/or chemotherapy), and the patient's overall health 29,30 . While advancements in treatment methods and multidisciplinary approaches have improved outcomes in certain instances, challenges such as delayed diagnosis, aggressive disease biology, restricted access to advanced medical care, and resistance to standard treatments may affect survival rates 31 …”