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Objective: To explore the impact of textbook outcome (TO) on long‐term survival in oral cancer surgery. Subjects and Methods: In total, 386 patients with tumor resection, neck dissection (ND), and reconstruction between 2011 and 2020 were included. TO was defined as negative margin; adequate ND; no 3‐day emergency room revisit; no 30‐day readmission; and length of stay ≤22 days. Multivariate Cox regression was used to evaluate the impact of TO and 5‐year overall survival (OS). Results: The TO rate was 35%. Younger age, subsite in buccal area, Charlson Comorbidity Index Score of 0, higher body mass index, higher hemoglobin, higher albumin, and unilateral ND were associated with TO. 5‐year OS was 70.5% in overall TO patients and 49.0% in non‐TO patients (HR, 0.47; 95% CI, 0.31–0.70; p < 0.001). Non‐TO was associated with an increased mortality rate (aHR, 1.73; 95% CI, 1.14–2.63) after adjusting other factors and the result remained robust with inverse probability of treatment weighting analysis. The impact of TO on OS was more significant in age <60, advanced stage, and diagnosis year before 2018. Conclusion: Not achieving TO in oral cancer surgery was associated with worse long‐term outcome. TO could be used as a proxy for surgical quality improvement. [ABSTRACT FROM AUTHOR]

Recurrent oral cancer incurred grave outcome. Tumor microenvironment features, like tumor-infiltrating lymphocytes (TILs) or tumor stromal ratio (TSR) had prognostic significance in various cancers. We aimed to evaluate the impact of stromal categorization which incorporated the stromal TILs and TSR on survival outcomes in recurrent oral cancer. 162 patients who received surgery-based treatment between 2010 and 2020 were recruited. Outcomes were 5-year overall survival (OS) and disease-specific survival (DSS). The impact of stromal categorization of recurrent primary tumor or node on 5-year OS and DSS were assessed with the Kaplan-Meier method. Multivariate analysis was performed, incorporating variables at initial treatment and salvage surgery. Patients were further categorized using a survival decision tree. Mean age was 56.1 (SD, 11.3) years; 153 patients (94.4%) were male; 51 patients (31.5%) had stromal category III. Local recurrence occurred in 94 patients (58%), regional recurrence in 55 (34%), and loco-regional recurrence in 13 (8%). Patients with stromal category III had poorer 5-year OS and DSS. Prior radiotherapy, advanced recurrent stage, positive surgical margin, and stromal category III were independent prognosticators for 5-year OS and DSS. In survival decision tree analysis, patients with prior radiotherapy and stromal category III had the worst outcomes. Stromal categorization is associated with outcomes in recurrent oral cancer. Patients with poor prognosticators, such as stromal categorization III, prior radiation, and advanced stage may require closer follow-up and intensive treatment. [ABSTRACT FROM AUTHOR]