title: Outcome of heavily pretreated recurrent oral squamous cell carcinoma after salvage resection: A monocentric retrospective analysis.
abstract: OBJECTIVE
  The goals of the present study were to analyze survival data of patients who received salvage surgery due to recurrent oral squamous cell carcinoma (OSCC) of the oral cavity with curative intent, and to investigate the feasibility of microvascular flap reconstruction in a heavily pretreated patient cohort.
  
  
  METHODS
  A total of 32 patients who received salvage surgery due to recurrent OSCC were included. The cohort was analyzed in regard to relevant clinical and pathological features. Survival was estimated by using Kaplan-Meier analysis and verified in a multivariate Cox regression model.
  
  
  RESULTS
  All patients recovered well from surgery. The most common severe complication was free flap failure in 7 patients (24.1%). R0-resection was achieved in 16 patients (50%). Univariate Kaplan-Meier analysis showed that the estimated overall survival and disease-free survival of all patients after 24 months were 37.8% and 30.9%, respectively. Multivariate testing identified R1-resection was the only independent predictor of treatment failure.
  
  
  CONCLUSIONS
  Salvage surgery is the only potential curative treatment option in recurrent OSCC. Microvascular reconstruction is feasible in heavily pretreated patients, but it is associated with a higher free flap failure rate. Recurrent OSCC in heavily pretreated patients shows different biological behavior. Further prospective clinical and molecular studies are needed to develop a better molecular understanding of recurrent OSCC and the best and safest individual therapeutic strategy.
authors.affiliation: Department for Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: Dominik.horn@med.uni-heidelberg.de.
authors.forename: Dominik
authors.initials: D
authors.lastname: Horn
authors.affiliation: Department for Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Bodem
authors.affiliation: Department for Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Freudlsperger
authors.affiliation: Department for Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Zittel
authors.affiliation: Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Wilko
authors.initials: W
authors.lastname: Weichert
authors.affiliation: Department for Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Department for Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Kolja
authors.initials: K
authors.lastname: Freier
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis
keywords: Heavy pretreatment; Microvascular reconstruction; Recurrent oral squamous cell carcinoma; Salvage surgery