Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2023; 27(04): e733-e743
DOI: 10.1055/s-0042-1750764
Systematic Review

Marginal versus Segmental Mandibulectomy in the Treatment of Oral Cavity Cancer: A Systematic Review and Meta-analysis

Carlos Miguel Chiesa-Estomba 
1   Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario de Donostia, San Sebastian, Guipuzcoa, Spain
,
Miguel Mayo-Yanez
2   Department of ENT, Hospital Juan Canalejo de La Coruña, A Coruna, Galicia, Spain
,
Giuditta Manelli
3   Department of ENT, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
,
Gabriele Molteni
4   Department of ENT, Università degli Studi di Verona, Verona, Veneto, Italy
,
Jerome Lechien
5   Department of ENT, Hôpital Foch, Suresnes, Île-de-France, France
,
Nicolas Fakhry
6   Department of ENT, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azu, France
,
Antoine Melkane
7   Department of ENT, Hôpital Hôtel Dieu de France, Beirut, Lebanon
,
Christian Calvo-Henriquez
8   Department of ENT, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
,
David Kalfert
9   Department of ENT, Charles University, Praha, Czech Republic
,
Tareck Ayad
10   Department of ENT, University of Montreal Hospital Centre, Montreal, Quebec, Canada
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Introduction Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy in the oral cavity. Two types of mandibular resections have been described: the segmental mandibulectomy and the marginal mandibulectomy. Both may have a different impact over the quality of life, oncological prognosis, and functional or aesthetic result.

Objectives The aim of this study was to systematically explore the literature to determine the survival outcomes and disease control rates in patients who underwent segmental or marginal mandibulectomy for OCSCC with histological evidence of cortical and medullary bone invasion.

Data Synthesis This review involved a systematic search of the electronic databases MEDLINE/PUBMED, Google Scholar, Ovid Medline, Embase, and Scopus including articles from 1985 to 2019. Fifteen articles were included for qualitative analysis and 11 articles were considered for meta-analysis calculations. All of them correspond to retrospective cohort studies.

Conclusion This systematic review reveals the low-level evidence regarding the impact over local control or survival according to the type of mandibulectomy. Our results need to be considered with precaution according to the limited evidence available. We just found difference regarding the 5-year disease-free survival, and a tendency in favor of segmental mandibulectomy was confirmed when medullary invasion was evident.

Keywords

oral cancer - oral cavity - mandible - mandibulectomy - survival

Supplementary Material



Publication History

Received: 24 February 2022

Accepted: 15 May 2022

Article published online:
11 April 2023

© 2023. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Ferlay J, Colombet M, Soerjomataram I. et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019; 144 (08) 1941-1953
    CrossrefPubMedGoogle Scholar
  • 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66 (01) 7-30
    CrossrefPubMedGoogle Scholar
  • 3 Weatherspoon DJ, Chattopadhyay A, Boroumand S, Garcia I. Oral cavity and oropharyngeal cancer incidence trends and disparities in the United States: 2000-2010. Cancer Epidemiol 2015; 39 (04) 497-504
    CrossrefPubMedGoogle Scholar
  • 4 Van Cann EM, Dom M, Koole R, Merkx MAW, Stoelinga PJW. Health related quality of life after mandibular resection for oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2005; 41 (07) 687-693
    CrossrefPubMedGoogle Scholar
  • 5 Van Cann EM, Oyen WJ, Koole R, Stoelinga PJ. Bone SPECT reduces the number of unnecessary mandibular resections in patients with squamous cell carcinoma. Oral Oncol 2006; 42 (04) 409-414
    CrossrefPubMedGoogle Scholar
  • 6 Van Cann EM, Koole R, Oyen WJG. et al. Assessment of mandibular invasion of squamous cell carcinoma by various modes of imaging: constructing a diagnostic algorithm. Int J Oral Maxillofac Surg 2008; 37 (06) 535-541
    CrossrefPubMedGoogle Scholar
  • 7 Hendrikx AWF, Maal T, Dieleman F, Van Cann EM, Merkx MAW. Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study. Int J Oral Maxillofac Surg 2010; 39 (05) 436-439
    CrossrefPubMedGoogle Scholar
  • 8 Kansy K, Mueller AA, Mücke T. et al. A worldwide comparison of the management of surgical treatment of advanced oral cancer. J Craniomaxillofac Surg 2018; 46 (03) 511-520
    CrossrefPubMedGoogle Scholar
  • 9 O'Brien CJ, Lee KK, Castle GK, Hughes CJ. Comprehensive treatment strategy for oral and oropharyngeal cancer. Am J Surg 1992; 164 (06) 582-586
    CrossrefPubMedGoogle Scholar
  • 10 McGregor IA, MacDonald DG. Mandibular osteotomy in the surgical approach to the oral cavity. Head Neck Surg 1983; 5 (05) 457-462
    CrossrefPubMedGoogle Scholar
  • 11 Systematic and literature review resources. 2011 http://distillercer.com/resources . Accessed January 2019.
    PubMedGoogle Scholar
  • 12 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    CrossrefPubMedGoogle Scholar
  • 13 Howick J, Chalmers I, Glasziou P. et al. The 2011 Oxford CEBM levels of evidence (introductory document). http://www.cebm.net/index.aspx?o=5653 . Published 2011. Accessed May 12, 2019.
    Google Scholar
  • 14 Study Quality Assessment Tools [Internet]. NHLBI, NIH Available from: https://www.nhlbi.nih.gov/health-topics/study- quality- assessment- tools.
    Google Scholar
  • 15 Wald Jr RM, Calcaterra TC. Lower alveolar carcinoma. Segmental v marginal resection. Arch Otolaryngol 1983; 109 (09) 578-582
    CrossrefPubMedGoogle Scholar
  • 16 Barttelbort SW, Bahn SL, Ariyan SA. Rim mandibulectomy for cancer of the oral cavity. Am J Surg 1987; 154 (04) 423-428
    CrossrefPubMedGoogle Scholar
  • 17 Soo KC, Spiro RH, King W, Harvey W, Strong EW. Squamous carcinoma of the gums. Am J Surg 1988; 156 (04) 281-285
    CrossrefPubMedGoogle Scholar
  • 18 Totsuka Y, Usui Y, Tei K. et al. Results of surgical treatment for squamous carcinoma of the lower alveolus: segmental vs. marginal resection. Head Neck 1991; 13 (02) 114-120
    CrossrefPubMedGoogle Scholar
  • 19 Dubner S, Heller KS. Local control of squamous cell carcinoma following marginal and segmental mandibulectomy. Head Neck 1993; 15 (01) 29-32
    CrossrefPubMedGoogle Scholar
  • 20 Overholt SM, Eicher SA, Wolf P, Weber RS. Prognostic factors affecting outcome in lower gingival carcinoma. Laryngoscope 1996; 106 (11) 1335-1339
    CrossrefPubMedGoogle Scholar
  • 21 Ord RA, Sarmadi M, Papadimitrou J. A comparison of segmental and marginal bony resection for oral squamous cell carcinoma involving the mandible. J Oral Maxillofac Surg 1997; 55 (05) 470-477 , discussion 477–478
    CrossrefPubMedGoogle Scholar
  • 22 Ash CS, Nason RW, Abdoh AA, Cohen MA. Prognostic implications of mandibular invasion in oral cancer. Head Neck 2000; 22 (08) 794-798
    CrossrefPubMedGoogle Scholar
  • 23 Nie X, Wei F. Marginal resection for the mandible management of oral squamous cell carcinoma. J Chin Oncol 2000; 6: 156-157
    Google Scholar
  • 24 Werning JW, Byers RM, Novas MA, Roberts D. Preoperative assessment for and outcomes of mandibular conservation surgery. Head Neck 2001; 23 (12) 1024-1030
    CrossrefPubMedGoogle Scholar
  • 25 Shaw RJ, Brown JS, Woolgar JA, Lowe D, Rogers SN, Vaughan ED. The influence of the pattern of mandibular invasion on recurrence and survival in oral squamous cell carcinoma. Head Neck 2004; 26 (10) 861-869
    CrossrefPubMedGoogle Scholar
  • 26 Patel RS, Dirven R, Clark JR, Swinson BD, Gao K, O'Brien CJ. The prognostic impact of extent of bone invasion and extent of bone resection in oral carcinoma. Laryngoscope 2008; 118 (05) 780-785
    CrossrefPubMedGoogle Scholar
  • 27 Qiu Y, Lin L, Shi B, Zhu X. Does Different Mandibulectomy (Marginal vs Segmental) Affect the Prognosis in Patients With Oral Squamous Cell Carcinoma?. J Oral Maxillofac Surg 2018; 76 (05) 1117-1122
    CrossrefPubMedGoogle Scholar
  • 28 Sproll CK, Holtmann H, Schorn LK. et al. Mandible handling in the surgical treatment of oral squamous cell carcinoma: lessons from clinical results after marginal and segmental mandibulectomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129 (06) 556-564
    CrossrefPubMedGoogle Scholar
  • 29 Stoop CC, de Bree R, Rosenberg AJWP, van Gemert JTM, Forouzanfar T, Van Cann EM. Locoregional recurrence rate and disease-specific survival following marginal vs segmental resection for oral squamous cell carcinoma with mandibular bone invasion. J Surg Oncol 2020; 122: 646-652
    CrossrefPubMedGoogle Scholar
  • 30 Gou L, Yang W, Qiao X. et al. Marginal or segmental mandibulectomy: treatment modality selection for oral cancer: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2018; 47 (01) 1-10 DOI: 10.1016/j.ijom.2017.07.019.
    CrossrefPubMedGoogle Scholar
  • 31 Marchetta FC, Sako K, Murphy JB. The periosteum of the mandible and intraoral carcinoma. Am J Surg 1971; 122 (06) 711-713
    CrossrefPubMedGoogle Scholar
  • 32 Carter RL, Tsao SW, Burman JF, Pittam MR, Clifford P, Shaw HJ. Patterns and mechanisms of bone invasion by squamous carcinomas of the head and neck. Am J Surg 1983; 146 (04) 451-455
    CrossrefPubMedGoogle Scholar
  • 33 Yue LE, Sharif KF, Sims JR. et al. Oral squamous carcinoma: Aggressive tumor pattern of invasion predicts direct mandible invasion. Head Neck 2020; 42 (11) 3171-3178 DOI: 10.1002/hed.26360.
    CrossrefPubMedGoogle Scholar
  • 34 O'Brien CJ, Carter RL, Soo KC, Barr LC, Hamlyn PJ, Shaw HJ. Invasion of the mandible by squamous carcinomas of the oral cavity and oropharynx. Head Neck Surg 1986; 8 (04) 247-256
    CrossrefPubMedGoogle Scholar
  • 35 Brown JS, Browne RM. Factors influencing the patterns of invasion of the mandible by oral squamous cell carcinoma. Int J Oral Maxillofac Surg 1995; 24 (06) 417-426
    CrossrefPubMedGoogle Scholar
  • 36 Brown JS, Kalavrezos N, D'Souza J, Lowe D, Magennis P, Woolgar JA. Factors that influence the method of mandibular resection in the management of oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2002; 40 (04) 275-284
    CrossrefPubMedGoogle Scholar
  • 37 Brown JS, Lowe D, Kalavrezos N, D'Souza J, Magennis P, Woolgar J. Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma. Head Neck 2002; 24 (04) 370-383
    CrossrefPubMedGoogle Scholar
  • 38 Brown JS, Griffith JF, Phelps PD, Browne RM. A comparison of different imaging modalities and direct inspection after periosteal stripping in predicting the invasion of the mandible by oral squamous cell carcinoma. Br J Oral Maxillofac Surg 1994; 32 (06) 347-359
    CrossrefPubMedGoogle Scholar
  • 39 Gu DH, Yoon DY, Park CH. et al. CT, MR, (18)F-FDG PET/CT, and their combined use for the assessment of mandibular invasion by squamous cell carcinomas of the oral cavity. Acta Radiol 2010; 51 (10) 1111-1119
    CrossrefPubMedGoogle Scholar
  • 40 van den Brekel MW, Runne RW, Smeele LE, Tiwari RM, Snow GB, Castelijns JA. Assessment of tumour invasion into the mandible: the value of different imaging techniques. Eur Radiol 1998; 8 (09) 1552-1557
    CrossrefPubMedGoogle Scholar
  • 41 Uribe S, Rojas LA, Rosas CF. Accuracy of imaging methods for detection of bone tissue invasion in patients with oral squamous cell carcinoma. Dentomaxillofac Radiol 2013; 42 (06) 20120346
    CrossrefPubMedGoogle Scholar
  • 42 Li C, Yang W, Men Y, Wu F, Pan J, Li L. Magnetic resonance imaging for diagnosis of mandibular involvement from head and neck cancers: a systematic review and meta-analysis. PLoS One 2014; 9 (11) e112267
    CrossrefPubMedGoogle Scholar
  • 43 Bouhir S, Mortuaire G, Dubrulle-Berthelot F. et al. Radiological assessment of mandibular invasion in squamous cell carcinoma of the oral cavity and oropharynx. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136 (05) 361-366
    CrossrefPubMedGoogle Scholar
  • 44 Chen YL, Kuo SW, Fang KH, Hao SP. Prognostic impact of marginal mandibulectomy in the presence of superficial bone invasion and the nononcologic outcome. Head Neck 2011; 33 (05) 708-713
    CrossrefPubMedGoogle Scholar
  • 45 O'Brien CJ, Adams JR, McNeil EB. et al. Influence of bone invasion and extent of mandibular resection on local control of cancers of the oral cavity and oropharynx. Int J Oral Maxillofac Surg 2003; 32 (05) 492-497
    CrossrefPubMedGoogle Scholar
  • 46 De Vicente JC, Recio OR, Pendás SL, López-Arranz JS. Oral squamous cell carcinoma of the mandibular region: A survival study. Head Neck 2001; 23 (07) 536-543
    CrossrefPubMedGoogle Scholar
  • 47 Spiro RH, Guillamondegui Jr O, Paulino AF, Huvos AG. Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck 1999; 21 (05) 408-413
    CrossrefPubMedGoogle Scholar
  • 48 O'Brien CJ, Lauer CS, Fredricks S. et al. Tumor thickness influences prognosis of T1 and T2 oral cavity cancer–but what thickness?. Head Neck 2003; 25 (11) 937-945
    CrossrefPubMedGoogle Scholar
  • 49 Kowalski LP, Sanabria A. Elective neck dissection in oral carcinoma: a critical review of the evidence. Acta Otorhinolaryngol Ital 2007; 27 (03) 113-117
    PubMedGoogle Scholar
  • 50 Brockhoff II HC, Kim RY, Braun TM, Skouteris C, Helman JI, Ward BB. Correlating the depth of invasion at specific anatomic locations with the risk for regional metastatic disease to lymph nodes in the neck for oral squamous cell carcinoma. Head Neck 2017; 39 (05) 974-979
    CrossrefPubMedGoogle Scholar
  • 51 Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 1997; 19 (03) 205-210
    CrossrefPubMedGoogle Scholar
  • 52 Kane SV, Gupta M, Kakade AC, D' Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol 2006; 32 (07) 795-803
    CrossrefPubMedGoogle Scholar
  • 53 Melchers LJ, Schuuring E, van Dijk BA. et al. Tumour infiltration depth ≥4  mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma. Oral Oncol 2012; 48 (04) 337-342
    CrossrefPubMedGoogle Scholar
  • 54 Tan WJ, Chia CS, Tan HK, Soo KC, Iyer NG. Prognostic significance of invasion depth in oral tongue squamous cell carcinoma. ORL J Otorhinolaryngol Relat Spec 2012; 74 (05) 264-270
    CrossrefPubMedGoogle Scholar
  • 55 Mannelli G, Comini LV, Piazza C. Surgical margins in oral squamous cell cancer: intraoperative evaluation and prognostic impact. Curr Opin Otolaryngol Head Neck Surg 2019; 27 (02) 98-103
    CrossrefPubMedGoogle Scholar