Salvage surgery for recurrent oral cavity squamous cell carcinoma: patient selection, reconstructive strategy, and a...

Loco-regional recurrence develops in up to 50% of patients with advanced-stage oral cavity squamous cell carcinoma (OCSCC) after primary treatment, and salvage surgery remains the only curative-intent intervention for resectable disease. Pooled 5-year overall survival following surgical salvage is approximately 40%, yet patient selection remains inconsistently structured and the reconstructive strategy for the previously treated field is inadequately addressed in existing reviews. This narrative review was performed to synthesize the current evidence on salvage surgery for recurrent OCSCC with emphasis on three insufficiently addressed domains: (1) prognostic stratification for surgical candidacy integrating disease-free interval, prior treatment intensity, recurrence stage, and performance status; (2) reconstructive feasibility assessment in the previously operated and irradiated field, including recipient vessel strategy and flap selection; and (3) integration of re-irradiation and emerging systemic therapies into salvage treatment planning. An expert-informed decision framework is proposed comprising four sequential assessment gates - oncological resectability, prognostic stratification, reconstructive feasibility, and adjuvant therapy sequencing - that links patient-level factors to surgical candidacy, reconstructive planning, and multimodality treatment. This framework groups patients into favorable, intermediate, and unfavorable salvage-risk categories to structure multidisciplinary discussion and management planning in a setting where validated decision tools remain limited. This review provides the surgical oncologist with a structured, evidence-informed approach to one of the most consequential treatment decisions in head and neck oncology.