The continuous evolution of concepts in compartmental resections for oral cavity cancer: principles, indications, and outcomes

Purpose of review: This paper is aimed at synthetizing the conceptual basis of compartmental surgery (CS) for tumours of the anterior (floor of mouth and oral tongue) as well as posterior (base of tongue, superior and inferior gingival-buccal sulcus extending into the masticator space and infratemporal fossa) oral cavity, its indications, and outcomes. Recent findings: In spite of numerous bioendoscopic, radiological, and surgical advancements in management of oral cancer, its oncologic surgical control continues to be hampered by a considerable risk of local recurrence rate. Use of a conventional approach based on an empirical 5 mm safe margin surrounding the lesion in its three-dimensional extension, even when associated to accurate frozen sections techniques, seems inadequate to improve the oncologic outcomes of these patients in the near future. In contrast, application of the CS concepts herein detailed seems to open new opportunities for increasing surgical radicality, while maintaining adequate functional outcomes when proper reconstructive techniques are applied. Summary: Even though further multicentric prospective studies are needed to confirm the replicability of the oncological results described by pioneers of the CS approach, as well as to quantify the functional outcomes obtained by its large-scale application, this surgical philosophy confirms its vitality, relentless diffusion, and progressive evolution in the head and neck cancer arena.