A New Surgical Strategy for a Rare but Aggressive Oral Cancer
A simplified look at a novel “compartmental” approach for buccal mucosa squamous cell carcinoma
Based on De Berardinis et al., 2025
Introduction: Why This Cancer Needs New Solutions
Buccal mucosa squamous cell carcinoma (BMSCC)—a cancer of the inner cheek—is relatively rare in Western countries, but when it does occur, it behaves aggressively. Compared to other oral cancers, tumors in this region have higher recurrence rates, especially within the first six months after treatment.
One major challenge is anatomy: unlike other oral subsites, the cheek doesn’t have strong tissue barriers that limit cancer spread. Tumor cells can easily infiltrate muscles, lymphatic pathways, and connective tissue, making complete removal difficult.
The current standard of care is radical surgery. However, surgeons still struggle to define where “complete removal” truly ends—especially at the deep surgical margins.
This study introduces a new surgical technique aiming to fix that problem.
What the Researchers Wanted to Address
Surgeons often use transoral and cervical approaches to excise these tumors, but these standard methods do not remove all structures between the tumor (T) and the neck lymph nodes (N)—a zone called the T-N tract.
The T-N tract includes:
Platysma muscle fibers
Facial artery and vein
Lymphatic networks
These structures act as “highways” for cancer to spread. The authors propose that removing the tumor together with the entire T-N tract in one piece (en-bloc) could improve cancer control.
What the Researchers Did: Introducing Compartmental Surgery
The team describes a new procedure called Buccal Mucosa Compartmental Surgery (BMCS). Instead of removing only the visible tumor, the surgeon removes the entire “compartment” at risk:
1. Tumor with wide margins (≥1 cm)
Including mucosa, submucosa, buccinator muscle, and vessel plane.
2. The full T-N tract
Which connects the buccal mucosa to neck lymph nodes (levels I–IV).
3. The corresponding neck dissection
Performed en-bloc, creating a continuous removal of all anatomical pathways where the cancer may travel.
The researchers also confirmed, via immunohistochemistry, that lymphatic vessels exist within the platysma muscle, supporting their theory that the muscle may serve as a spread pathway.
Case Example: How It Works in Practice
One highlighted case involved a 71-year-old male with:
A small (10 mm) buccal tumor
Large metastatic lymph nodes (up to 33 mm)
Final staging: cT2 N2b M0
The patient underwent BMCS with comprehensive neck dissection. Results:
All margins were cancer-free (R0)
A metastatic lymph node was found in the T-N tract—supporting the importance of removing it
Recovery was smooth, and after 28 months, the patient remained disease-free
What the Findings Suggest
Early experience and anatomical evidence indicate that BMCS may:
✔ Improve locoregional tumor control
By removing all soft-tissue pathways where cancer could spread.
✔ Allow better deep-margin clearance
A major challenge in buccal cancer surgery.
✔ Be especially helpful for intermediate-advanced tumors
Or any case with clinically positive lymph nodes.
✔ Reduce recurrence risk
Given that most recurrences are locoregional.
However, the technique is complex and carries risks—especially potential injury to the marginal mandibular nerve.
Limitations & Next Steps
Because buccal mucosa cancer is rare, the sample size is small. The authors note the need for:
Larger retrospective and prospective studies
Multicenter collaboration
Direct comparison with standard wide excision techniques
Future studies will help clarify whether BMCS should become a new standard.
Conclusion
This new surgical approach reframes buccal mucosa cancer not just as a localized tumor, but as a disease of its entire anatomical compartment. By resecting the tumor and its potential spread pathways en-bloc, surgeons may achieve safer margins and better long-term outcomes.
It is a promising technique—grounded in anatomy, supported by initial clinical outcomes, and worthy of broader investigation.
Original Article Reference
De Berardinis R, Tagliabue M, Chu F, Maffini F, Lepanto D, Fusco N, et al. Compartmental surgery for squamous cell carcinoma of the buccal mucosa: description of a new surgical technique. World Journal of Surgical Oncology. 2025;23:84.
DOI: 10.1186/s12957-025-03656-x