Marginal and segmental mandibulectomy in patients with oral cancer:: A statistical analysis of 106 cases

Purpose: The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the local control and survival after surgical treatment of oral cancer, according to these 2 different mandibular resection procedures. Patients and Methods: We conducted a retrospective study of a 20-year cohort of 106 patients who underwent marginal or segmental mandibulectomy for oral cancer. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the floor of the mouth, mandibular gingiva, retromolar trigone, tongue, buccal mucosa, or oropharynx. The type of mandibular resection and treatment outcome were compared, using an univariate analysis by the Pearson x(2) test, logistic regression model for multivariate analysis, and Kaplan-Meier method to determine survival. Results: The 5-year observed survival rate was 60.35%. The presence of histologic mandibular invasion increased the local recurrence rate. Early tumor stages (P = .02) were found to be associated with decreased local recurrence rates. Our findings indicate that tumor stage and size of mandibulectomy are more important than the type of mandibulectomy in predicting histologic bone involvement. The cases treated with a greater than 4 cm bone resection showed a lower survival rate than those treated with less than 4 cm mandibulectomy (P = .01). Patients in advanced stages (P = .006) and those with surgical margin (P = .0001) or the bone (P = .003) affected by the tumor showed a statistically significant lower survival rate. However, no statistically significant differences were found between patients treated by marginal or segmental mandibulectomy. Conclusions: Among the prognostic factors studied, the status of the surgical resection margin, the bony involvement and the size of mandibulectomy affected the prognosis for oral carcinoma. Mandibular conservation surgery is oncologically safe for patients with squamous carcinoma in early stages. The marginal technique was not associated with worse prognosis. (C) 2003 American Association of Oral and Maxillofacial Surgeons.