Benefit-risk appraisal of lip-split mandibular “swing” vs. transoral approaches to posterior oral/oropharyngeal carcinomas using number needed to treat, to harm, and likelihood to be helped or harmed

Elsevier

Available online 15 August 2022, 101837

Surgical OncologyHighlights•

Despite higher risks of wound dehiscence and orocutaneous fistulae, lip-split mandibuloplasty swing approach to posterior oral/oropharyngx carcinomas (PO/OPCs) provides a better benefit-risk profile in terms of complete tumor resection and fewer recurrences than transoral approach at 5-year follow-ups.

Frozen section biopsy results almost 100% represent complete tumor resection, and thereby, merit routine use in PO/OPC surgery.

Adverse event appraisal of surgical approaches to PO/OPCs using the University of Washington Quality of Life questionnaire version 4 (UW-QoLv4) may not be appropriate.

AbstractPurpose

s: To evaluate benefit-risk profiles of lip-split mandibular “swing” vs. transoral approaches (LS-MSA; TOA) to the American Joint Committee on Cancer (AJCC) stage I-III posterior oral/oropharyngeal carcinomas (PO/OPC).

Methods

Using a retrospective double-cohort study design, we enrolled stage I-III PO/OPC patients treated in two German medical centers during a 4-year interval. The predictor variable was surgical technique (LS-MSA/TOA), and main outcomes were complete resection with R0 margins (CR-R0), 5-year overall survival and recurrence (OS5; R5), and adverse events (AEs). Descriptive and bivariate statistics were computed with α = 95%. Benefit-risk profiles were investigated using number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LLH).

Results

At 5-year follow-ups of 202 subjects, LS-MSA caused significantly better CR-R0 (P = 0.001; NNT: 4) and fewer R5 (P = 0.003; NNT: 5), but more risks of wound dehiscence ([WD]; P = 0.01; NNH = 8), and orocutaneous fistula ([OCF]; P = 0.01; NNH: 10). LLH calculations demonstrated that LS-MSA was 2 and 1.6 times more likely to result in CR-R0 and fewer R5 than an incident of WD. There was no significant difference in OS5, postoperative infections (within 30 postoperative days) and AE domains according to the University of Washington Quality of Life questionnaire version 4 (UW-QoLv4) between the surgical approach groups.

Conclusions

Compared to TOA, LS-MSA is an efficacious and tolerable intervention for inspecting and eradicating stage I-III PO/OPCs, and reducing recurrences at 5-year follow-ups. Post-LS-MSA WD and OCF require meticulous concerns and more investigations.

Keywords

Surgical approach

Oral cancer

Oropharyngeal cancer

Benefit-risk profile

View full text

© 2022 Elsevier Ltd. All rights reserved.

留言 (0)

沒有登入
gif