Does a mandibular access osteotomy improve survival in pT2 oral tongue cancers? Retrospective study at a single institution.

The surgical approach to the resection of oral tongue cancers can involve transoral resection (TOR) or a temporary mandibulotomy access (TMA). There are no relevant guidelines, and the oncological safety of TOR needs consideration. The objective of this study was to investigate TMA and TOR in pT2 oral tongue cancer surgery with regard to cancer outcomes. Demographic, surgical, and histology data from primary pT2 tongue cancers were recorded and evaluated through multivariate Cox regression for local recurrence (LR), disease-free survival (DFS), and overall survival (OS). A total of 166 patients with pT2 primary oral tongue cancer fulfilled the inclusion criteria; TOR was used in 95 patients and TMA in 71 patients. The minimum follow-up was 29 months. Group comparisons showed a significantly higher frequency of perineural spread (P=0.013) in the TMA group; a higher frequency of involved margins on initial resection was seen in TOR patients (P=0.010). Adjuvant postoperative radiotherapy was preferred in the TMA group, in line with the high pN positive status. Multivariate Cox regression showed significantly higher LR and lower DFS in the TOR group despite stratification of the major prognostic factors. The 5-year survival rate was reduced to 82.2% in the TOR group, while it remained constant at 93.0% in the TMA group. TMA provided superior local control and DFS compared to TOR in pT2 tongue cancers.