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Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
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Computer-Assisted Versus Freehand Surgery in Oncological Margins Control for Oral Squamous Cell Carcinomas: A

Alice Marzi Manfroni1, Otto Pietro Scaccini1, Francesco Ceccariglia1,2

  • 1Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.

Head & Neck
|November 17, 2025
PubMed
Summary

Computer-assisted surgery (CAS) significantly reduces positive margins in oral cancer surgery, improving disease-free survival. This technology offers advantages for precise oncological margin control in head and neck cancer patients.

Keywords:
CAD/CAM technologycomputer‐assisted surgerycutting guidesoral squamous cell carcinomaresection margins

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Area of Science:

  • Oncologic Surgery
  • Maxillofacial Surgery
  • Surgical Technology

Background:

  • Achieving optimal resection margins is critical for prognosis in head and neck cancer surgery.
  • Traditional freehand techniques may present challenges in ensuring complete tumor removal.

Purpose of the Study:

  • To compare the effectiveness of computer-assisted surgery (CAS) versus traditional freehand surgery in achieving negative resection margins for oral cancer.
  • To evaluate the impact of CAS on disease-free survival (DFS) and overall survival (OS) in patients with oral squamous cell carcinoma.

Main Methods:

  • Retrospective case-control study of 80 patients with stage T3 or T4 oral squamous cell carcinoma.
  • Comparison of margin status (negative, close, positive) between CAS and freehand groups.
  • Logistic regression and Cox models, including sensitivity analyses with inverse probability of treatment weighting (IPTW), were used to analyze outcomes.

Main Results:

  • Computer-assisted surgery (CAS) was associated with a significantly lower rate of positive margins (OR 0.24).
  • Disease-free survival (DFS) was significantly improved in the CAS group (HR 0.41-0.46).
  • Nodal status was identified as the most significant prognostic factor; overall survival (OS) showed no significant difference between groups.

Conclusions:

  • Computer-assisted surgery (CAS) technology demonstrates significant advantages in achieving precise oncological margin control for oral squamous cell carcinomas.
  • CAS may lead to improved disease control and potentially better long-term outcomes for patients undergoing maxillofacial oncologic surgery.