Navigation-assisted surgery using an image-guided platform improves margin control and survival in advanced oral...

Negative surgical margins are essential for curative resection in oral squamous cell carcinoma (OSCC), yet adequate clearance in very advanced tumors can be limited by complex craniofacial anatomy. This single-center retrospective cohort study screened 826 surgically treated patients at MacKay Memorial Hospital (2014-2024) and identified 109 patients with American Joint Committee on Cancer 8th edn T4b disease who met inclusion criteria, including 52 who underwent navigation-assisted resection using the Brainlab image-guided platform and 57 who underwent conventional surgery. The primary endpoint was pathological margin status (negative, ≥5 mm; close, ≥1 mm to <5 mm; positive, <1 mm or at the inked margin), and secondary endpoints were disease-free survival (DFS) and overall survival (OS). Navigation-assisted surgery achieved a higher negative-margin rate than conventional surgery (55.7% vs 22.8%; P = 0.0016), with fewer close margins (28.8% vs 56.1%) and fewer positive margins (15.3% vs 21.1%). Median DFS was 27.9 months with navigation and 15.4 months with conventional surgery (log-rank P = 0.041), and median OS was 36.37 vs 18.4 months (log-rank P = 0.030); 5-year OS rates were 33.3% and 17.8%, respectively. In multivariable Cox regression adjusting for nodal stage, perineural invasion, and lymphovascular invasion, navigation-assisted surgery was associated with improved DFS (adjusted hazard ratio (aHR) 0.501; 95% confidence interval (CI) 0.315-0.825; P = 0.011) and OS (aHR 0.547; 95% CI 0.337-0.888; P = 0.015). Navigation-assisted surgery was associated with improved margin control and longer survival in surgically treated T4b OSCC, supporting its use as an adjunct for anatomically complex resections.