Reclassifying cT4b buccal mucosa/gingivobuccal complex cancers: do we need to change?

T4b carcinomas are termed as very locally advanced carcinomas of the oral cavity and are deemed borderline resectable or unresectable. The role of surgery for these patients is not well defined. We therefore aimed to relook at the role of surgery for cT4b carcinoma of the oral cavity. We evaluated 596 patients with cT4 oral cancers. A total of 218 patients were staged as cT4b based on clinicoradiological findings. These patients underwent bite composite resection either before or after neoadjuvant chemotherapy. Additional compartmental infratemporal fossa (ITF) clearance was done in patients with involvement of more than two of following structures: medial and lateral pterygoid muscles, pterygoid plates, temporalis at the tip of the coronoid process, high masseter, retroantral fat pad. Oncological outcomes and prognostic factors were estimated. Patients were treated between August 2013 and May 2021. Compartmental ITF clearance was done in 93 patients; the rest had standard surgical clearance. A total of 112 patients had node-positive disease. The median (range) age of the group was 50 (24-84) years. On a median follow up of 54 months (IQR: 1-111 months), 136 (62.4%) were alive and 82 (37.6%) had died. Five-year locoregional control, disease-free survival, and overall survival were 54%, 52%, and 59%, respectively. On multivariate analysis, the presence of nodal disease, perineural invasion, and bone involvement were statistically significant factors affecting overall survival. Surgery for cT4b oral cancer is therefore feasible and associated with acceptable oncological outcomes.