Surgical salvage improves survival for recurrent oral cavity and oropharyngeal squamous cell carcinoma in the era of immunotherapy

Background Recurrence in oral cavity (OC) and oropharyngeal (OP) squamous cell carcinoma (SCC) remains common, with poor long-term survival despite advances in systemic therapy. While surgical salvage has historically conferred a survival advantage, the emergence of immunotherapy has prompted re-evaluation of optimal salvage strategies. Methods This retrospective review included 193 patients treated for recurrent OC/OP SCC at a tertiary academic center between 2016 and 2021. Patients were stratified by recurrence pattern and first salvage modality (surgery, radiation, immunotherapy, or chemotherapy). The primary endpoint was overall survival (OS) following recurrence, which was evaluated using Kaplan–Meier curves and log-rank testing. Cox proportional hazards regression identified independent predictors of survival. Results Among 193 patients (53 % OC, 47 % OP), 69 % experienced locoregional recurrence. Salvage surgery was performed in 59 % of cases and was more common in OC than OP primaries (71 % vs 44 %, p < 0.001). Among patients with locoregional recurrence, two-year OS was highest with surgery (85 %; median OS 91.4 months), followed by radiation (70 %; 82.5 months), immunotherapy (32 %; 21.7 months), and chemotherapy (0 %; 7.9 months). In multivariable analysis, ECOG ≥ 1 (HR 1.90, p = 0.03) and T stage ≥ 3 (HR 2.22, p = 0.01) were associated with worse OS, while surgical salvage was independently (HR 1.96, p = 0.03) associated with improved survival. Conclusions Within this retrospective cohort, surgical salvage remained associated with superior survival in recurrent locoregional OC/OP SCC. Radiation may provide benefits when surgery is not feasible, and immunotherapy remains an important option for unresectable disease. These findings support multidisciplinary evaluation to guide salvage treatment selection.