# Mandibular preservation vs. sacrifice following neoadjuvant immunotherapy in locally advanced oral cancer: a comparative study of surgical and quality-of-life outcomes

## TL;DR

The study compares outcomes of preserving versus removing the jawbone in advanced oral cancer patients after immunotherapy, finding that preserving the jaw leads to fewer complications and better quality of life without affecting cancer control.

## Contribution

This study demonstrates that jawbone preservation after immunotherapy can reduce complications and improve quality of life without compromising cancer outcomes in select patients.

## Key findings

- Mandibular preservation was associated with significantly fewer major complications compared to mandibular sacrifice.
- Patients with jaw preservation had shorter hospital stays and lower gastrostomy dependence.
- Quality of life scores were consistently better in the mandibular preservation group from 6 months post-surgery.

## Abstract

This study compared surgical complication, quality of life (QoL), functional recovery, and oncologic outcomes between mandibular preservation (MP) and mandibular sacrificing (MS) procedures in patients with locally advanced oral squamous cell carcinoma (OSCC) abutting the mandible who achieved a radiologic complete response (rCR) following neoadjuvant immunotherapy (NAT).

A retrospective cohort study was conducted on 78 patients who achieved a primary site rCR post-NAT. Patients were allocated to an MP cohort (n=42) or an MS cohort (n=36) based on the definitive surgery performed. Primary outcomes were major complications (Clavien-Dindo ≥ III) and longitudinal QoL (EORTC QLQ-C30/H&N35). Secondary outcomes included functional recovery and 3-year oncologic survival.

The MP cohort experienced significantly fewer major complications than the MS cohort (2.4% vs. 19.4%, p=0.013), a finding that held in multivariable analysis (aOR: 3.85, p=0.008). The MP cohort also demonstrated a significantly shorter median hospital stay (9 vs. 16 days, p<0.001), lower rates of gastrostomy dependence at discharge (28.6% vs. 63.9%, p=0.002) and at 3 months (0% vs. 11.1%, p=0.037), and superior QoL scores across multiple domains from 6 months onwards. With a median follow-up of 3 years, there were no significant differences in local (p=0.534), regional (p=0.305), or disease-free survival (p=0.332) between the cohorts.

For select patients with OSCC achieving rCR after NAT, a mandibular preservation strategy is associated with significantly less postoperative complication, improved functional recovery and quality of life, while not compromising short-term oncologic control in this cohort. These findings suggest the feasibility of challenging the paradigm of mandatory mandibular sacrifice in exceptional responders, pending further prospective validation.