IntroductionT4b carcinoma are termed as very locally advanced carcinoma of oral cavity. These tumors are deemed borderline resectable or unresectable. Role of surgery for these group of patients is not very well defined. We aimed to relook role of surgery for cT4b carcinoma oral cavity. Material and methodsWe evaluated 596 patients of cT4 oral cancers. Two hundred eighteen patients were stagged as cT4b based on clinico- radiological findings. These patients underwent bite composite resection either upfront or post neoadjuvant chemotherapy. Additional compartmental infratemporal fossa clearance was done for patients with involvement of more than 2 of following structures: medial and lateral pterygoid muscles, pterygoid plates, temporalis at tip of coronoid process, high masseter involvement and retroantral fat pad involvement. Oncological outcomes and prognostic factors were estimated. ResultsPatients were treated between Aug 2013 to May 2021. Compartmental ITF clearance was done for 93 patients and rest had standard surgical clearance. One hundred and twelve patients had node positive disease. The median age of group was 50 years (Range= 24 to 84 years). On a median follow up of 54 months (IQR = 1-111 months), 136 (62.4%) were alive and 82 (37.6%) patients died. Five year Loco-regional control, disease free survival and overall survival was 54%, 52% and 59% respectively. On multivariate analysis, presence of nodal disease, perineural invasion and bone involvement were significant factors affecting overall survival. ConclusionSurgery for cT4b oral cancer is feasible and associated with acceptable oncological outcomes.