[Salvage surgery in squamous cell carcinoma of the oral cavity]

The objective of this work was to evaluate the results of salvage surgery in squamous cell carcinoma of the oral cavity. In the period 1983-1998, 127 patients consecutively underwent surgical treatment. Of these, 80 cases had not been treated previously (Group I), while 47 patients had come under our observation after radiotherapy alone or other treatment had failed (Group II). Local recurrence was observed in 29 cases, local/regional in 10 cases, and exclusively regional in eight cases. In both groups, the surgical T-approach was prevalently transoral (55 cases in Group I and 24 in Group II). A transmandibular approach was taken in most of the remaining patients (22 cases in Group I and 16 in Group II). One hundred patients (65 in Group I and 35 in Group II) underwent laterocervical neck dissection. The neoplasms in group I were staged as follows: pT1, 29%; pT2, 37.5%; pT3, 12.5%; pT4, 21%. In group II, the neoplasms were stages as: pT0, 17%; pT1, 21%; pT2, 38%; pT3, 13%; pT4, 11% (Group II). The overall 5-year survival rate was 38% and the overall determinate 5-year survival rate was 45%, distributed as follows in the two groups: 51% of the patients in Group I, 36% of the patients in Group II (p = 0.01). Restricting the analysis to Group II, the difference in the three year survival rate was 54% among the patients at stages I-II and 25% among the patients suffering from a recurrence at stages III-IV (p = 0.04). In patients whose recurrence was limited to the primary tumor, survival at 3 years was 49%; in those whose recurrence also had nodal involvement, survival was 27% (p = 0.05). Lastly, the 5-year survival rate was 45% in the patients whose recurrence had been diagnosed late and only 24% in the 24 patients whose recurrence had been diagnosed within a year of prior treatment (p = 0.09). In conclusion, the life expectancy of patients undergoing salvage surgery for squamous cell carcinoma of the oral cavity is significantly less with respect to patients undergoing first round treatment. This difference appears significant only in patients with a recurrence that was diagnosed at an advanced stage. In accordance with the previously published data, an early recurrence (within a year) and the presence of a recurrence in the neck are unfavorable prognostic factors.