A restrospective analysis of surgery for the oral cavity and oropharyngeal squamous cell carcinoma

Abstract Objectives: To conduct a multifactorial analysis of patients with oral cavity and oropharyngeal squamous cell carcinoma surgically treated at the Royal Marsden Hospital. Methods: This is a 20-year retrospective analysis (1983–2003) with reference to site, age, gender, surgical approach, survival, etc. Results: There were 306 patients (251 fresh and 55 recurrent cases) with oral cavity and oropharyngeal squamous cell carcinomas (oral cavity, 203; oropharynx, 100; unknown, 3). Of these, 202 patients were male and 104 were female (M:F = 1.9:1) patients. Mean age at diagnosis was 57 years. The subsite distribution was as follows: oral cavity, T-125, BM-39, FOM-39; oropharynx, LW-65, AW-23, PW-6, and SW-6. An external surgical approach was performed in 196 cases and a peroral approach in 120 cases. A mandibulectomy was done in 47 cases (hemimandibulectomy, 27; segmental mandibulectomy, 9; and marginal mandibulectomy, 11) and glossectomy in 129 patients (partial, 71; hemi, 37; subtotal, 3; and total, 18). Two hundred eleven patients were subjected to radiotherapy (radical, 113; postop, 93; palliative, 5, and iridium implants, 4). Locoregional recurrence occurred in 95 patients with distant metastasis in 20 patients. Overall cause-specific survival at 1, 3, and 5 years was 86%, 66%, and 61%, respectively. Conclusions: Minimizing morbidity while ensuring good oncologic tissue margins with any approach to the oral cavity and oropharynx is difficult, but it is imperative. When factors were considered singly, poor prognosis was associated with late stage postop radiotherapy and external surgical approach. The effect of metastasis during follow-up was associated with a poor prognosis for survival. Nodal status and age were not significant predictors of survival.