The impact of lip-split mandibulotomy on patients treated for pT2 oral tongue squamous cell carcinoma: a study of 224 patients

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

PURPOSE

s: 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).

METHODS

Using 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).

RESULTS

At 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.

CONCLUSIONS

Compared 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.