Margin Status and Locoregional Recurrence in Early Oral Cavity Squamous Cell Carcinoma: Analyzing Re-resection Outcomes

Saturday, October 11, 2025

9:54 AM - 10:00 AM EDT

Location: 127

Disclosure(s):

Naomi C. Wang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The impact of surgical margin status and re-resection on locoregional recurrence in early oral cavity squamous cell carcinoma (OCSCC) remains controversial. This study evaluates recurrence patterns among patients with true negative (TN) margins, those re-resected to negative (RRN) margins, and those with positive margins.

Methods: Retrospective analysis of 245 patients with cT1-2N0 OCSCC at a single tertiary care center from 2005 to 2018. Patients were stratified by final margin status: TN (n=203), RRN (n=25), and positive (n=17). Primary outcome was local recurrence at 5 years. Fisher's exact test was used for statistical comparisons, and multivariable logistic regression was performed to adjust for adjuvant radiation therapy.

Results: Of the 254 patients, 53.2% were male and 46.8% female with an average age of 59.6±14.1 years. The most common oral cavity subsite was the anterior two thirds of the oral tongue at 45.3%. 67.3% underwent elective neck dissection. 13.4% had an initial positive margin requiring re-resection. 11.0% and 22.8% underwent adjuvant chemotherapy and radiotherapy, respectively. Local recurrence rates were 14.3% (29/203) for TN, 28.0% (7/25) for RRN, and 52.9% (9/17) for positive margins. After controlling for adjuvant radiation therapy in multivariable analysis, positive margins remained significantly associated with higher local recurrence compared to TN margins (OR=8.40, p< 0.001). RRN margins maintained significantly higher local recurrence rates than TN margins (OR=2.47, p=0.039) but trended toward lower recurrence than positive margins (p=0.0702). Radiation therapy showed an independent protective effect (OR=0.65, p< 0.001).

Conclusions: RRN margins should not be considered oncologically equivalent to TN margins, as demonstrated by significantly higher local recurrence rates. While re-resection improves outcomes compared to positive margins, these findings suggest that patients with RRN margins may benefit from more aggressive adjuvant therapy, similar to those with close or positive margins.

Presenting Author(s)

HB

Hannah Brown, MD

University of Kansas Medical Center
Kansas City, Kansas, United States

Disclosure information not submitted.

Co-Author(s)

Naomi C. Wang, MD

Resident
University of Kansas Medical Center Department of Otolaryngology– Head & Neck Surgery
Kansas City, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Rahul Alapati, MD

Otolaryngology-Head and Neck Surgery Resident
University of Kansas Medical Center
Kansas City, KS, United States

Disclosure information not submitted.
Uma R. Ramesh, MD

Clinical Research Fellow
University of Kansas Medical Center
kansas city, MO, United States

Disclosure information not submitted.
Ameen Amanian, MD FRCSC MSE

Clinical Instructor
University of Kansas Medical Center
Kelowna, BC, Canada

Disclosure information not submitted.
Andres M. Bur, MD

Associate Professor
Kansas University Physicians Inc
Kansas City, Kansas, United States

Disclosure information not submitted.

Senior Author(s)

Andres M. Bur, MD

Associate Professor
Kansas University Physicians Inc
Kansas City, Kansas, United States

Disclosure information not submitted.