Lip-split Mandibulectomy Versus Lip-mandible Preservation Technique for Oral and Oropharyngeal Cancer: a Systematic Review and Meta-analysis of Comparative Studies

Bincan Sun; Chengwen Gan; Yan Tang; Feiya Zhu

doi:10.1097/JS9.0000000000002176

Lip-split Mandibulectomy Versus Lip-mandible Preservation Technique for Oral and Oropharyngeal Cancer: a Systematic Review and Meta-analysis of Comparative Studies

Int J Surg. 2024 Dec 24. doi: 10.1097/JS9.0000000000002176. Online ahead of print.

Authors

Bincan Sun^{1

2}, Chengwen Gan³, Yan Tang⁴, Feiya Zhu^{1

5

6

7}

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, P. R. China.
² Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, P. R. China.
³ Department of Stomatology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, P. R. China.
⁴ Department of Nursing, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, P. R. China.
⁵ Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, P. R. China.
⁶ Institute of Oral Cancer and Precancerous Lesions, Central South University, Changsha, P. R. China.
⁷ National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Peking University School and Hospital of Stomatology, Beijing, P. R. China.

PMID: 39715146
DOI: 10.1097/JS9.0000000000002176

Abstract

Background: Many studies have compared lip-splitting mandibulotomy (LSM) and lip-mandible preservation (LMP) techniques in oral and oropharyngeal cancer (OOPC) patients with inconsistent conclusions. Evidence-based recommendations for the optimal surgical approach for treating OOPC are lacking.

Methods: The Cochrane Library, Pubmed, Embase, Web of Science, WAN-FANG, CQVIP, and China National Knowledge Infrastructure were systematically searched to identify studies that compared LSM versus LMP for OOPC. An additional search of the gray literature was performed using Google Scholar, OpenGrey and ProQuest Dissertations & Theses Global.Survival rate, recurrence rate, surgical margin, perioperative outcomes, postoperative complications and functional status were assessed. The standard mean difference (SMD) and odds ratio (OR) with a 95% CI were pooled using fixed-effect or random-effect models.

Results: Four randomized controlled trials, five case-control studies and twenty cohort studies including a total of 2622 patients were identified. The LSM approach significantly increased postoperative complications such as mandibular osteomyelitis/osteoradionecrosis (OR = 4.57; 95% CI = 1.20 ~ 17.39; p = 0.026), fistula (OR = 1.5; 95% CI = 1.05 ~ 2.15; p = 0.027), and flap infection (OR = 2.96; 95% CI = 1.49 ~ 5.87; p = 0.002), while LMP improved facial appearance (SMD = -0.65; 95% CI = -1.05 ~-0.25; p = 0.002). Meta-analyses showed no significant difference in survival rate (OR = 1.07; 95% CI = 0.83 ~ 1.38; p = 0.59), total recurrence (OR = 1.15; 95% CI = 0.87 ~ 1.52; p = 0.325), local recurrence (OR = 1.39; 95% CI = 0.88 ~ 2.19; p = 0.163), operation duration (SMD = 0.19; 95% CI = -0.75 ~ 1.13; p = 0.688), length of hospital stay (SMD = 0.48; 95% CI = -0.27 ~ 1.22; p = 0.208), volume of blood loss (SMD = 0.43; 95% CI = -0.17 ~ 1.03; p = 0.156), surgical margin (OR = 1.01; 95% CI = 0.72 ~ 1.41; p = 0.947), hematoma/seroma (OR = 1.01; 95% CI = 0.46 ~ 2.25; p = 0.972), wound infection (OR = 1.28; 95% CI = 0.92 ~ 1.79; p = 0.145), swallowing (SMD = -0.33; 95% CI = -0.91 ~ 0.24; p = 0.428) and speech (SMD = -0.14; 95% CI = -0.44 ~ 0.17; p = 0.381) between the LSM and LMP groups.

Conclusion: These findings suggest that LMP may be a safe and efficient alternative to LSM for treating OOPC patients with decreased mandibular osteomyelitis/osteoradionecrosis, fistula, flap infection, and a better aesthetic outcome.