Salvage surgery for patients with residual/persistent diseases after improper or insufficient treatment of oral squamous cell carcinoma: can we rectify these mistakes?

BMC Cancer

Chunyue Ma¹  Yue He¹  Zhonglong Liu¹  Surui Sheng¹  Xiao Tang¹  Xiaoguang Li¹  Weijin Gao² 

[1] Department of Oral & Maxillofacial – Head & Neck Oncology, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, 200011, Shanghai, Shanghai, China;Department of Oral & Maxillofacial – Head & Neck Oncology, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, 200011, Shanghai, Shanghai, China;Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, Zhejiang, China;

关键词: Salvage surgery;    Oral squamous cell carcinoma;    Persistent disease;    Recurrent disease;    Surgical margin;    Survival;    Management;   

DOI  :  10.1186/s12885-021-08600-2

来源: Springer

【 摘 要 】

BackgroundPatterns of failure after treatment of oral and squamous cell carcinomas (OSCC) are diversified, with recurrences being one of the common causes. A special group of patients are sometimes encountered in the outpatient clinic for improper or insufficient initial treatment with reports of positive margins, implying residual/persistent diseases. The question of whether these patients can be surgically salvaged remain unanswered.MethodsA retrospective study was performed between January 2013 and December 2017 for patients with residual or rapid recurrent (within 3 months) OSCCs, who received salvage surgeries in our institution. The patients with residual/persistent OSCCs were those with microscopic or macroscopic positive surgical margins, while those with rapid recurrent OSCCs were those with close or negative margins, but unabated painful symptoms right after treatment. Both clinicopathological and prognostic variables were analyzed. The focus was also directed towards lessons for possible initial mistakes, resulting in these residual/persistent diseases.ResultsOf 103 patients, 68 (66%) were men, with mean age of 56.3 years. The overall survival reached 60.2%. Regarding the primary OSCC status, most of our patients (n = 75, 72.8%) were diagnosed with ycT2–3 stages. Besides, most patients were found with macroscopic residual diseases (52.4%) before our salvage surgery. The sizes of the residual/persistent OSCCs were generally under 4 cm (87.3%) with minimally residual in 21 (20.4%). Among all the variables, primary T stage (p = 0.003), and residual lesion size (p < 0.001) were significantly associated with the prognosis in multivariate analysis. Though the causes for the initial surgical failure were multifactorial, most were stemmed from poor planning and unstandardized execution.ConclusionsCases with residual/persistent OSCCs were mostly due to mistakes which could have been avoided under well-round treatment plans and careful surgical practice. Salvage surgery for cases with smaller residual/persistent OSCCs is still feasible with acceptable outcomes.

【 授权许可】

CC BY