Surgery for maxillary oral squamous cell carcinoma: the effect of surgical resection margins and elective neck dissection on oncological outcomes

Woo, S; DeAngelis, A; Koo, K; Kranz, S; Nastri, A; Iseli, TA; Fua, T; Wiesenfeld, D

Author(s): Woo, S; DeAngelis, A; Koo, K; Kranz, S; Nastri, A; Iseli, TA; Fua, T; Wiesenfeld, D;
Details: Publication Year 2023-03,Volume 52,Issue #3,Page 283-290
Journal Title: International Journal of Oral and Maxillofacial Surgery
Publication Type: Research article
Abstract: Maxillary oral squamous cell carcinoma (OSCC) is uncommon. Surgical resection is challenging due to the anatomy, and the role of elective neck dissection (END) is not well-defined. A retrospective cohort study of patients with maxillary OSCC treated with primary surgery between 2007 and 2019 was conducted. Primary tumours of sinonasal origin with extension into the oral cavity were excluded. Survival analysis was performed using Kaplan-Meier and Cox proportional hazards models. Sixty-seven patients were included; mean follow-up was 55 months. On univariate analysis, clear (>/=5 mm) margins were associated with higher disease-free (68% vs 36%, P = 0.019) and overall survival (75% vs 36%, P = 0.004) than close/involved (<5 mm) margins. In clinically node-negative patients, the risk of occult cervical metastasis in tumours with depth of invasion (DOI) >/= 3 mm and T2-4 tumours was 22% and 25%, respectively. END in these groups was associated with a lower rate of loco-regional recurrence (DOI >/=3 mm subgroup: 5% vs 38%, P = 0.029; T2-4 subgroup: 6% vs 50%, P = 0.028) and longer time to recurrence (DOI >/=3 mm subgroup: 119 months vs 96 months, P = 0.042; T2-4 subgroup: 117 months vs 56 months, P = 0.031) than observation of the neck. On multivariate analysis, close/involved margins were associated with an increased risk of overall mortality (hazard ratio 3.4, 95% confidence interval 1.0-11.3, P = 0.043) and disease recurrence (hazard ratio 2.8, 95% confidence interval 1.1-7.1, P = 0.031). In maxillary OSCC, a >/= 5 mm histological margin should remain the goal of ablative surgery. END should be considered in tumours with DOI >/= 3 mm.
Publisher: Elsevier
Keywords: Humans; Squamous Cell Carcinoma of Head and Neck/surgery; *Carcinoma, Squamous Cell/pathology; *Mouth Neoplasms/surgery/pathology; Neck Dissection; Retrospective Studies; Margins of Excision; Neoplasm Staging; Neoplasm Recurrence, Local/pathology; *Head and Neck Neoplasms/surgery; Head and neck cancer; Maxilla; Oral cancer; Oral squamous cell carcinoma; Surgical margins
Department(s): Radiation Oncology
PubMed ID: 35851181
Publisher's Version: https://doi.org/10.1016/j.ijom.2022.06.015
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-07-11 06:23:41

Last Modified: 2023-07-11 06:25:37