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INTRODUCTION OR ("surgery" [All Fields] AND "oral" [All Fields]) OR "oral
surgery" [All Fields] OR ("surgery" [All Fields] AND "oral"
Nowadays, recurrence in oral squamous cell carcinoma [All Fields]) OR "surgery, oral" [All Fields]) AND ("carcinoma,
(OSCC) remains the main cause for failure in oral cancer squamous cell" [MeSH Terms] OR ("carcinoma" [All Fields]
patients, despite advances in surgical techniques and AND "squamous" [All Fields] AND "cell" [All Fields]) OR
chemo-radiotherapy (CRT) protocols. In fact, treatment "squamous cell carcinoma" [All Fields] OR ("squamous" [All
of OSCC with radical surgery followed by radiotherapy Fields] AND "cell" [All Fields] AND "carcinoma" [All Fields])).
(RT) has been reported to be unsuccessful in 25% to References were explored to identify other articles.
[1]
48% of the cases. This recurrence can be local-oral
cavity or oropharynx-, regional- in the neck, ipsilateral, A total amount of 188 studies were found using the above
contralateral or both-, or loco-regional. Today, salvage reported searching parameters. We only included studies
surgery is generally considered to be the best choice published in the English language and those dealing
for treating recurrent OSCC patients that have been with “squamous cell carcinoma of the oral cavity and/or
previously irradiated, although cure rates are still poor. oropharynx”, excluding those exclusively referring to the
Also, when dealing with regional recurrences, primary larynx, hypopharynx or other sites of the head and neck,
treatment seems to determine overall outcome following such as paranasal sinuses or salivary gland neoplasms.
salvage surgery, with poorer rates in previously irradiated If an overall approach to multiple locations of the upper
and surgically treated necks. [2] aero-digestive tract was performed in a particular study,
only those locations referred to the oral cavity and/or
Otherwise two conditions are mandatory for this subset oropharynx were taken into consideration regarding
of patients to undergo salvage surgery: (1) the recurrence data output, if available. However, if no specific data
has still to be resectable in terms of resectability criteria was offered for “oral cavity” and “oropharynx” and only
within the head and neck region; and (2) the patient has general data was offered, then the series was rejected
to be operable in terms of an aesthesiologic critera. Other for inclusion in the meta-analysis. Articles dealing with
eligible options are generally behind in terms of curative CRT as the salvage treatment of choice for recurrent
intention such as re-irradiation or CRT, while palliative tumors were also excluded from this review. Besides,
chemotherapy and supportive care are reserved for non- articles specifically focusing on the reliability of the used
curative patients. reconstructive method or surgical technique were not
considered if data referring to prognosis and/or survival
In considering the treatment to be performed, especially analysis was not performed.
for those patients with advanced recurrences, there is
a trend to outweigh the importance of quality of life Then, a manual screening of articles’ abstracts was
for the patient, even more than in the first approach performed in order to explore the role of salvage surgery
to the disease, in which survival is far from any other in squamous cell carcinoma of the oral cavity and
consideration, such as function and aesthetic impairment. oropharynx from the ultimate complete 16 years. The
Moreover if one takes into consideration that many following technical bibliographic exclusion criteria were
of these advanced recurrent patients may undergo a applied: (1) case reports; (2) technical reports; (3) animal
permanent tracheostomy and/or a gastrostomy, a realistic or in vitro studies; (4) review articles; (5) uncontrolled
evaluation of the probability of cure versus the generated clinical studies; and (6) publications in which the same
morbidity has to be evaluated and sincerely approached data were published by the same group of researchers.
with the patient and his/her family before salvage surgery The abstracts of yielded results were reviewed and the
is to be offered for the recurrent patient.
full text of those with apparent relevance was obtained.
The references of identified articles were crosschecked
The purpose of the present study was to select and analyze for unidentified articles. The author carefully assessed
the most representative papers published in the literature the eligibility of all studies retrieved from the databases.
concerning OSCC, specifically dealing with salvage surgery A total amount of 13 original papers were finally selected
following primary treatment by surgery with or without by
postoperative radiotherapy, specifically focusing in the oral according to the provided inclusion and exclusion criteria.
cavity and oropharynx locations.
RESULTS
METHODS
Summary of results from the selected
A bibliography search on MEDLINE and EMBASE databases studies
for studies published from March 2000 to March 2016 From the review of the selected papers, several common
was conducted, with the searching terms: (("salvage weakness among them have to be highlighted, such
therapy" [MeSH Terms] OR ("salvage" [All Fields] AND as the difficulty in establishing prospective series of
"therapy" [All Fields]) OR "salvage therapy" [All Fields] OR patients submitted for different treatment modalities, the
"salvage" [All Fields]) AND ("surgery, oral" [MeSH Terms] variation in the series’ size, and the lack of homogeneity
190 Plast Aesthet Res || Volume 3 || June 24, 2016