Salvage surgery for patients with residual/persistent diseases after improper or insufficient treatment of oral squamous cell carcinoma: can we rectify these mistakes?

Yue He,Chunyue Ma,Xiaoguang Li,Xiao Tang,Zhonglong Liu,Surui Sheng,Weijin Gao

doi:10.1186/s12885-021-08600-2

Abstract

BackgroundPatterns of failure after treatment of oral and squamous cell carcinomas (OSCC) are diversified, with recurrences being one of the common causes. A special group of patients are sometimes encountered in the outpatient clinic for improper or insufficient initial treatment with reports of positive margins, implying residual/persistent diseases. The question of whether these patients can be surgically salvaged remain unanswered.MethodsA retrospective study was performed between January 2013 and December 2017 for patients with residual or rapid recurrent (within 3 months) OSCCs, who received salvage surgeries in our institution. The patients with residual/persistent OSCCs were those with microscopic or macroscopic positive surgical margins, while those with rapid recurrent OSCCs were those with close or negative margins, but unabated painful symptoms right after treatment. Both clinicopathological and prognostic variables were analyzed. The focus was also directed towards lessons for possible initial mistakes, resulting in these residual/persistent diseases.ResultsOf 103 patients, 68 (66%) were men, with mean age of 56.3 years. The overall survival reached 60.2%. Regarding the primary OSCC status, most of our patients (n = 75, 72.8%) were diagnosed with ycT2–3 stages. Besides, most patients were found with macroscopic residual diseases (52.4%) before our salvage surgery. The sizes of the residual/persistent OSCCs were generally under 4 cm (87.3%) with minimally residual in 21 (20.4%). Among all the variables, primary T stage (p = 0.003), and residual lesion size (p < 0.001) were significantly associated with the prognosis in multivariate analysis. Though the causes for the initial surgical failure were multifactorial, most were stemmed from poor planning and unstandardized execution.ConclusionsCases with residual/persistent OSCCs were mostly due to mistakes which could have been avoided under well-round treatment plans and careful surgical practice. Salvage surgery for cases with smaller residual/persistent OSCCs is still feasible with acceptable outcomes.

Highlights

Patterns of failure after treatment of oral and squamous cell carcinomas (OSCC) are diversified, with recurrences being one of the common causes
Cases with residual/persistent OSCCs were mostly due to mistakes which could have been avoided under well-round treatment plans and careful surgical practice
Salvage surgery for cases with smaller residual/ persistent OSCCs is still feasible with acceptable outcomes

Summary

Introduction

Patterns of failure after treatment of oral and squamous cell carcinomas (OSCC) are diversified, with recurrences being one of the common causes. Some recent studies started to recognize such patient subgroups as with rather “residual/persistent” diseases for their particular treatment history, most still regarded these patterns of failure as “relapsed” lesions [2, 8, 9] The philosophy behind such insistence was primarily established on the sole concern with margin positivity, irrespective of several other clinicopathologic factors, such as history of adjuvant therapy (blurring true margins), accuracy of margin assessment (specimen-driven or tumor-bed driven), number of margins, times of secondary negative margins (i.e. initially positive margins), tumor sizes, infiltrative depths and extirpation routes (surgical exposure) [2, 10,11,12,13]. Without scrutinizing prior surgical procedures, in our opinion, it is probably a bit far-fetched to assigning local surgical failures of heterogenous causes into one single category of recurrence, especially for patients who “recur” rapidly within just weeks after primary surgical resections

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