Surgery is still the primary choice of treatment for patients with functionally resectable oral cancers. In the past few years however, new treatments such as induction chemotherapy and postoperative chemoradiation have emerged and opinions about the definition of ‘functionally resectable’ have changed. This study investigates the current role of surgery in the changing landscape of oral cancer treatment. A Pubmed search and a search of the Standards and Guidelines Evidence database were conducted. After selection based on title, abstract and year of publication, eight guidelines describing the multidisciplinary treatment of oral- or head and neck cancer, remained. The guidelines agreed upon the fact that, if functionally feasible surgery is the first choice for the treatment of oral cancer. In some cases, for example metastatic neck disease or T1/T2 tumors, radiotherapy or chemotherapy is also considered a valid alternative. Comparing these guidelines, it is interesting to notice that important research is interpreted in different ways which leads to different guidelines. This means that the same tumor will receive a different primary treatment in different parts of the world. Even though new therapies are currently mostly used as an adjuvant therapy, their role is slowly expanding. These therapies have their own disadvantages. For example patients treated with primary chemoradiation will have less salvage options in case of recurrence. We therefore conclude that, though the role of surgery seems to become smaller, surgery is still the best option for functionally resectable disease. The discussion about the definition ‘functional’ remains subjective and may also change with new reconstructive options.
The declining role of surgery in the treatment of oral cancer?
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