What question did this study set out to answer?

The study aims to compare the outcomes of mandibular preservation and sacrifice in patients with advanced oral squamous cell carcinoma after immunotherapy.

March 7, 2026Open Access

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

Key Points

The study aims to compare the outcomes of mandibular preservation and sacrifice in patients with advanced oral squamous cell carcinoma after immunotherapy.
Retrospective cohort study of 78 patients with a radiologic complete response post-neoadjuvant immunotherapy.
Patients were divided into two cohorts: mandibular preservation (MP) and mandibular sacrifice (MS).
Primary outcomes included surgical complications and quality of life scores.
The MP cohort had significantly fewer major complications (2.4%) compared to the MS cohort (19.4%), p=0.013.
Median hospital stay was shorter in the MP group (9 days) vs. MS (16 days), p<0.001.
The MP cohort had lower gastrostomy dependence at discharge and 3 months (0% vs. 11.1%, p=0.037).

Abstract

Objective 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). Methods 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/HN35). Secondary outcomes included functional recovery and 3-year oncologic survival. Results 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, p0.001), 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. Conclusion 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.

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