Benefit-risk appraisal of lip-split mandibular “swing” vs. transoral approaches to posterior oral/oropharyngeal carcinomas using number needed to treat, to harm, and likelihood to be helped or harmed

Abstract

Purposes: To evaluate benefit-risk profiles of lip-split mandibular “swing” vs. transoral approaches (LS-MSA; TOA) to the American Joint Committee on Cancer (AJCC) stage I-III posterior oral/oropharyngeal carcinomas (PO/OPC). MethodsUsing a retrospective double-cohort study design, we enrolled stage I-III PO/OPC patients treated in two German medical centers during a 4-year interval. The predictor variable was surgical technique (LS-MSA/TOA), and main outcomes were complete resection with R0 margins (CR-R0), 5-year overall survival and recurrence (OS5; R5), and adverse events (AEs). Descriptive and bivariate statistics were computed with α = 95%. Benefit-risk profiles were investigated using number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LLH). ResultsAt 5-year follow-ups of 202 subjects, LS-MSA caused significantly better CR-R0 (P = 0.001; NNT: 4) and fewer R5 (P = 0.003; NNT: 5), but more risks of wound dehiscence ([WD]; P = 0.01; NNH = 8), and orocutaneous fistula ([OCF]; P = 0.01; NNH: 10). LLH calculations demonstrated that LS-MSA was 2 and 1.6 times more likely to result in CR-R0 and fewer R5 than an incident of WD. There was no significant difference in OS5, postoperative infections (within 30 postoperative days) and AE domains according to the University of Washington Quality of Life questionnaire version 4 (UW-QoLv4) between the surgical approach groups. ConclusionsCompared to TOA, LS-MSA is an efficacious and tolerable intervention for inspecting and eradicating stage I-III PO/OPCs, and reducing recurrences at 5-year follow-ups. Post-LS-MSA WD and OCF require meticulous concerns and more investigations.