Response‐Adapted Surgery Following Neoadjuvant Chemotherapy in Oral Cavity Squamous Cell Carcinoma: An Era‐Based Retrospective Cohort Study

BACKGROUND: Evidence regarding response-adapted resection after neoadjuvant chemotherapy (NACT) in oral cavity squamous cell carcinoma remains limited. METHODS: We compared conventional-era (2018-2021) and response-adapted-era (2022-2024) surgery after NACT. Margins, recurrence, 2-year survival, and surgical outcomes were assessed. RESULTS: Among 129 patients (58 conventional; 71 response-adapted), positive margins occurred in 3.4% versus 1.4% and local recurrence in 12.1% versus 7.0%. Two-year disease-free survival (DFS) was 56.6% versus 67.8% (log-rank p = 0.135). Adjusted DFS HR for the response-adapted era was 0.54 (95% CI 0.28-1.04; p = 0.066). ENE predicted inferior DFS (HR 3.60; p < 0.001). Responder-only analysis showed no significant survival difference. CONCLUSIONS: No observed increase in positive margins or local recurrence accompanied the later surgical strategy. Retrospective selection, unequal follow-up, and limited events preclude conclusions of noninferiority or a causal survival benefit.