Computer-Assisted Versus Freehand Surgery in Oncological Margins Control for Oral Squamous Cell Carcinomas: A Retrospective Case-Control Clinical Study

Background: Margin control is a crucial prognostic factor in head and neck oncological surgery. This retrospective case-control study aims to assess the superiority of computer-assisted surgery compared to traditional surgery in achieving optimal resection margins in maxillofacial oncologic surgery. Methods: Eighty patients with stage T3 or T4 oral squamous cell carcinoma were included, equally divided into computer-assisted surgery (CAS) and freehand groups. Negative, close, and positive margin rates were compared. Logistic regression with Firth's correction and multivariable Cox models for disease-free survival (DFS) and overall survival (OS) were applied, with tobacco and alcohol included as covariates. Sensitivity analyses used inverse probability of treatment weighting (IPTW)-weighted models. Results: CAS was associated with a significantly lower risk of positive margins (OR 0.24; 95% CI: 0.06–0.78; p = 0.01), confirmed in the IPTW analysis. DFS was significantly improved with CAS in both multivariable and IPTW Cox models (HR 0.41 and 0.46, respectively), while OS showed no significant benefit. Nodal status emerged as the strongest prognostic factor. Conclusions: Despite its univocality, the CAS technology seems to offer significant advantages in achieving precise oncological margin control for oral squamous cell carcinomas.