ArticleBMC oral health2026
Submental island flap reconstruction in the era of neoadjuvant immunochemotherapy: a propensity score-matched cohort study in oral squamous cell carcinoma.
Article in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe submental island flap (SIF) is a versatile reconstructive option for oral cavity defects, but concerns regarding recurrences in level I lymph node basins have persisted in the context of neoadjuvant immunochemotherapy (NICT). This study evaluated the clinical outcomes and the incidence of loco-regional recurrences following SIF reconstruction in patients with oral squamous cell carcinoma (OSCC) treated with or without NICT.
methodsThis retrospective cohort study included 279 patients who underwent SIF reconstruction for OSCC between 2018 and 2024, divided into NICT (n = 135) and upfront surgery (US, n = 144) groups. Propensity score matching (1:1) yielded 85 patients per group with balanced baseline characteristics. Primary outcome was loco-regional recurrence (LRR) analyzed using competing risks regression. Secondary outcomes included overall survival (OS), recurrence patterns, and flap-related complications.
resultsAfter matching, the NICT group demonstrated significantly less LRR (cumulative incidence 11.8% vs. 30.6%; Gray's test, p = 0.004) and OS (3-year OS 91.8% vs. 85.7%; log-rank p = 0.041). On multivariable analysis, NICT remained an independent protective factor for LRR (adjusted SHR = 0.38; 95% CI: 0.20-0.72; p = 0.003) and OS (adjusted HR = 0.51; 95% CI: 0.27-0.96; p = 0.038). Critically, no recurrences occurred within level I or along the flap subcutaneous tract in either group. Pathological analysis confirmed complete level I lymph node clearance (median yield 7 nodes) with only two NICT patients having positive level I nodes. Flap complication rates were comparable between groups, with no total flap losses.
conclusionsIn this cohort, SIF reconstruction combined with meticulous level I lymph node clearance was feasible and not associated with observed level I or flap tract recurrences. NICT appears to be associated with significantly improved survival without compromising flap outcomes.
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