The role of salvage surgery in oral squamous cell carcinoma

Abstract

Aim: To select and analyze the most representative papers published in the literature concerning oral squamous cell carcinoma (OSCC), specifically dealing with salvage surgery following primary treatment by surgery with or without by postoperative radiotherapy, specifically focusing in the oral cavity and oropharynx locations. Methods: A bibliography search on MEDLINE and EMBASE databases for studies published from March 2000 to March 2016 was conducted. The authors only included studies published in the English language and those dealing with "squamous cell carcinoma of the oral cavity and/or oropharynx". The following technical bibliographic exclusion criteria were applied: (1) case reports; (2) technical report; (3) animal or in vitro studies; (4) review articles; (5) uncontrolled clinical studies; and (6) publications in which the same data were published by the same group of researchers. The abstracts of yielded results were reviewed and the full text of those with apparent relevance was obtained. Results: A total amount of 188 studies were found using the above reported searching parameters. Thirteen original papers were finally selected according to the inclusion and exclusion criteria. From 1,692 analyzed patients, overall recurrence rate was 26% (range: 15-41.7%), with a mean 47.3%, 35.1% and 10.9% local, regional and loco-regional recurrence, respectively. Mean 5-year overall survival rate was 40.2% (range: 37.5-42.9%). Conclusion: Salvage surgery is the best option for the treatment of recurrent OSCC, either local, regional or loco-regional, with the highest rates in terms of survival and with an acceptable morbidity.

Factors affecting prognosis in locoregional recurrence of oral squamous cell carcinoma

“…This study represents the experience of a tertiary head and neck oncology centre in the United Kingdom, examining outcomes after OSCC recurrences. With median survival of 7.4 months, and 1‐year survival of 32.5%, our data are commensurate with other similar published studies …”

“…Our study identifies a number of factors that can be used as prog- Despite advances in imaging, surgical reconstruction and adjuvant treatment, outcomes following recurrence of OSCC remain poor, with 5-year survival of <40%. 4,11,12 Salvage surgery for recurrent OSCC is technically challenging, 3 and can lead to poor speech, swallowing and appearance, and increased risk of complications such as poor healing, salivary fistulae and perioperative mortality, 20,21 with an associated poor quality of life. Poor survival outcomes and significant risks oblige both the multidisciplinary team (MDT) and the patient to weigh these factors carefully when considering salvage F I G U R E 2 Kaplan-Meier graph illustrating overall survival, stratified by whether the multidisciplinary team elected to treat palliatively or with curative intent F I G U R E 3 Kaplan-Meier graph illustrating overall survival, stratified by whether the recurrence was at the primary site (local) within the regional lymph nodes (regional) or both (locoregional) surgery.…”

“…Outcomes following recurrence of OSCC are poor, with 5‐year survival reported between 33%‐40% . Early recurrence after treatment and the presence of extranodal extension (ENE) in affected lymph nodes are particularly poor prognostic indicators in recurrent OSCC …”

“…4,7,9,10 Outcomes following recurrence of OSCC are poor, with 5-year survival reported between 33%-40%. 4,[11][12][13] Early recurrence after treatment and the presence of extranodal extension (ENE) in affected lymph nodes are particularly poor prognostic indicators in recurrent OSCC. 14,15 Complete surgical excision with clear margins is the gold standard for treatment of primary OSCC with curative intent.…”

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery

“…Overall recurrence rate from a meta-analysis of 1,692 oral cavity cancer patients was 26%, with a mean local recurrence rate of 47.3%, regional recurrence rate of 35.1%, and locoregional recurrence rate of 10.9%; the 5-year OS after salvage surgery was 37.5%–42.9% [363]. Patients treated with salvage surgery showed better survival than did those treated with chemotherapy and/or RT [364].…”