{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:16:02Z","timestamp":1783610162321,"version":"3.55.0"},"reference-count":60,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background\/Objectives: Data on the value of tumor debulking surgery are scarce. We aimed to examine whether tumor debulking surgery followed by non-surgical treatment (cases) improves survival compared to non-surgical treatment alone (controls) in patients with head and neck cancer (HNC). Methods: We performed a systematic review of studies published in the databases PubMed, Scopus and Cochrane Central Register of Controlled Trials up to 10 December 2024. Studies evaluating tumor debulking surgery followed by non-surgical treatment and reporting survival (local recurrence, disease-free survival or overall survival) in subjects with HNC were included; case reports were excluded. We assessed the quality of observational studies with the Newcastle\u2013Ottawa Scale. Results: Among 11 retrospective small studies, three case\u2013control studies (one of high quality, i.e., 7\/9, and two of moderate quality, i.e., 6\/9 and 5\/9) suggested longer survival in 72 cases with predominantly squamous cell carcinoma (SCC) than in 40 controls with predominantly SCC. However, these survival benefits cannot be attributed solely to tumor debulking surgery, as confounding by indication is the most likely explanation. In supraglottic laryngeal SCC, one study reported a local recurrence-free survival rate and overall survival of 80% and 88%, respectively, in 25 cases compared with 86% and 77%, respectively, in 24 controls. In sarcomas, local recurrence-free survival was 25%, 65% and 100% for unknown resection margins, wide local excision and radical excision, respectively. Conclusions: The heterogeneous data indicate the need for higher-quality research. It would be interesting to investigate whether an attempt to surgically debulk paranasal sinus tumors while preserving adjacent vital organs (e.g., the orbit and\/or brain) should be incorporated into the treatment strategy for patients with extended paranasal sinus squamous cell carcinoma. Tumor debulking surgery did not improve survival in supraglottic laryngeal SCC or head and neck soft tissue sarcomas.<\/jats:p>","DOI":"10.3390\/curroncol33070409","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:17:51Z","timestamp":1783606671000},"page":"409","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Tumor Debulking Surgery in Improving Survival of Patients with Head and Neck Cancer: A Systematic Review"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4162-4261","authenticated-orcid":false,"given":"Aris I.","family":"Giotakis","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7888-4959","authenticated-orcid":false,"given":"Evangelos","family":"Tagkalos","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1413-7396","authenticated-orcid":false,"given":"Matthias","family":"Santer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Dejaco","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Hofauer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1002\/jso.24134","article-title":"The importance of margins in head and neck cancer","volume":"113","author":"Baddour","year":"2016","journal-title":"J. Surg. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.anl.2018.08.011","article-title":"Surgical margins in head and neck cancer: Intra- and postoperative considerations","volume":"46","author":"Triantafyllou","year":"2019","journal-title":"Auris Nasus Larynx"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1002\/hed.23110","article-title":"Surgical margins in head and neck cancer: A contemporary review","volume":"35","author":"Hinni","year":"2013","journal-title":"Head Neck"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4070","DOI":"10.1245\/s10434-019-07645-9","article-title":"Margin Analysis in Head and Neck Cancer: State of the Art and Future Directions","volume":"26","author":"Li","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11912-016-0540-y","article-title":"Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges","volume":"18","author":"Williams","year":"2016","journal-title":"Curr. Oncol. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1002\/hed.26460","article-title":"Untreated head and neck cancer: Natural history and associated factors","volume":"43","author":"Zolkind","year":"2021","journal-title":"Head Neck"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105185","DOI":"10.1016\/j.oraloncology.2021.105185","article-title":"Sinonasal cancer encroaching the orbit: Ablation or preservation?","volume":"114","author":"Ferrari","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Salfrant, M., Garcia, G., Guichard, J.P., Bidault, F., Reizine, D., Auperin, A., Bresson, D., Verillaud, B., Herman, P., and Moya-Plana, A. (2021). Imaging of Skull Base and Orbital Invasion in Sinonasal Cancer: Correlation with Histopathology. Cancers, 13.","DOI":"10.3390\/cancers13194963"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1177\/0003489414560431","article-title":"Prevertebral space invasion in head and neck cancer: Negative predictive value of imaging techniques","volume":"124","author":"Imre","year":"2015","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ruaro, A., Taboni, S., Ferrari, M., and Nicolai, P. (2025). Managing the Internal Carotid Artery in Head and Neck Cancer: Where Are We?. Critical Issues in Head and Neck Oncology: Key Concepts from the Ninth THNO Meeting, Springer Science+Business Media.","DOI":"10.1007\/978-3-031-84539-0_10"},{"key":"ref_11","unstructured":"Whalen, G. (2016). Principles of surgical oncology. Cancer Concepts: A Guidebook for the Non-Oncologist, University of Massachusetts Medical School."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1093\/jjco\/hyab107","article-title":"Debulking surgery for malignant tumors: The current status, evidence and future perspectives","volume":"51","author":"Hishida","year":"2021","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_13","first-page":"577","article-title":"Surgical debulking of tumors","volume":"155","author":"Silberman","year":"1982","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1177\/0194599816661326","article-title":"Tumor Debulking in the Management of Laryngeal Cancer Airway Obstruction","volume":"155","author":"Du","year":"2016","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_15","first-page":"111","article-title":"Surgical debulking of ovarian cancer: What difference does it make?","volume":"3","author":"Schorge","year":"2010","journal-title":"Rev. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Oppel, F., Gorner, M., and Sudhoff, H. (2020). The Potential of Tumor Debulking to Support Molecular Targeted Therapies. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.00801"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.bjorl.2019.07.004","article-title":"Debulking obstructing laryngeal cancers to avoid tracheotomy","volume":"87","author":"Gul","year":"2021","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1177\/019459989010300523","article-title":"Stomal recurrence after laryngectomy: Interrelated risk factor study","volume":"103","author":"Rubin","year":"1990","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_20","unstructured":"Else, T., Greenberg, S., and Fishbein, L. (2018). Hereditary Paraganglioma-Pheochromocytoma Syndromes, National Library of Medicine."},{"key":"ref_21","unstructured":"Howick, J., Chalmers, I., and Glasziou, P. (2011). OCEBM Levels of Evidence Working Group \u2018The Oxford 2011 Levels of Evidence\u2019: Oxford Centre for Evidence-Based Medicine, University of Oxford."},{"key":"ref_22","first-page":"1","article-title":"International Stroke Trial Collaborative Group; European Carotid Surgery Trial Collaborative Group. Evaluating non-randomised intervention studies","volume":"7, iii\u2013x","author":"Deeks","year":"2003","journal-title":"Health Technol. Assess."},{"key":"ref_23","unstructured":"Wells, G., and Shay, B. (2000). Data Extraction for Nonrandomised Systematic Reviews, University of Ottawa."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/00130404-200301000-00009","article-title":"Locoregional treatment for adult soft tissue sarcomas of the head and neck: An institutional review","volume":"9","author":"Barker","year":"2003","journal-title":"Cancer J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4671","DOI":"10.1002\/cncr.26084","article-title":"Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation","volume":"117","author":"Choe","year":"2011","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s11060-005-7285-z","article-title":"Primary sphenoid sinus neoplasms: A report of four cases with common clinical presentation treated with transsphenoidal surgery and adjuvant therapies","volume":"76","author":"Esposito","year":"2006","journal-title":"J. Neurooncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1002\/(SICI)1097-0142(19980101)82:1<104::AID-CNCR12>3.0.CO;2-6","article-title":"Squamous cell carcinoma of the maxillary sinus treated with radiation therapy and conservative surgery","volume":"82","author":"Itami","year":"1998","journal-title":"Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1093\/jjco\/hye038","article-title":"Influence of postsurgical residual tumor volume on local control in radiotherapy for maxillary sinus cancer","volume":"31","author":"Kawashima","year":"2001","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_29","first-page":"203","article-title":"Multimodal treatment for t1-2 supraglottic cancer: The impact of tumor location","volume":"34","author":"Suzuki","year":"2014","journal-title":"Anticancer Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0360-3016(00)00594-0","article-title":"Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma?","volume":"48","author":"Jansen","year":"2000","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1002\/hed.20966","article-title":"Primary cancer of the sphenoid sinus\u2014A GETTEC study","volume":"31","author":"Vedrine","year":"2009","journal-title":"Head Neck"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/bjs.1800750123","article-title":"Treatment of \u2018inoperable\u2019 neck nodes using surgical clearance and postoperative interstitial irradiation","volume":"75","author":"Stafford","year":"1988","journal-title":"Br. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.radonc.2006.06.012","article-title":"Manually after-loaded 192Ir low-dose rate brachytherapy after subtotal excision and flap reconstruction of recurrent cervical lymphadenopathy from head and neck cancer","volume":"80","author":"Nutting","year":"2006","journal-title":"Radiother. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.pdpdt.2015.06.001","article-title":"The use of photodynamic therapy as adjuvant therapy to surgery in recurrent malignant tumors of the paranasal sinuses","volume":"12","author":"Caesar","year":"2015","journal-title":"Photodiagnosis Photodyn. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1016\/j.wneu.2021.02.092","article-title":"Radical Exenteration of the Skull Base for End-Stage, Locally Advanced Sinonasal Malignancies: Challenging the Dictum of Unresectability","volume":"150","author":"Yeung","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.wneu.2016.02.019","article-title":"Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management","volume":"89","author":"Sakata","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"52","DOI":"10.3171\/2014.9.JNS141256","article-title":"Extended orbital exenteration for sinonasal malignancy with orbital apex extension: Surgical technique and clinical analysis","volume":"123","author":"Sugawara","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1177\/01945998211067503","article-title":"Including Surgical Resection in the Multimodal Management of Very Locally Advanced Sinonasal Cancer","volume":"167","author":"Karp","year":"2022","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1002\/lary.30545","article-title":"T4b Sinonasal Squamous Cell Carcinoma: Surgery Plus Radiotherapy May Contribute to Prolonged Survival","volume":"133","author":"Wang","year":"2023","journal-title":"Laryngoscope"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e70025","DOI":"10.1002\/lio2.70025","article-title":"Surgical resection and overall survival in cT4b sinonasal non-squamous cell carcinoma","volume":"9","author":"Patel","year":"2024","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e2403490121","DOI":"10.1073\/pnas.2403490121","article-title":"Heterogeneity in effect size estimates","volume":"121","author":"Holzmeister","year":"2024","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40246-021-00308-5","article-title":"High heterogeneity undermines generalization of differential expression results in RNA-Seq analysis","volume":"15","author":"Cui","year":"2021","journal-title":"Hum. Genom."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1002\/hed.25040","article-title":"Prognostic value of tumor volume in patients with head and neck squamous cell carcinoma treated with primary surgery","volume":"40","author":"Dejaco","year":"2018","journal-title":"Head Neck"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40644-015-0051-3","article-title":"Approximation of head and neck cancer volumes in contrast enhanced CT","volume":"15","author":"Dejaco","year":"2015","journal-title":"Cancer Imaging"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"105620","DOI":"10.1016\/j.oraloncology.2021.105620","article-title":"De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed?","volume":"123","author":"Golusinski","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s00106-020-00932-y","article-title":"Clear resection margins to avoid escalation of adjuvant therapy in oropharyngeal squamous cell carcinoma","volume":"69","author":"Mansour","year":"2021","journal-title":"HNO"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3680","DOI":"10.1097\/JS9.0000000000001306","article-title":"Surgical margins in head and neck squamous cell carcinoma: A narrative review","volume":"110","author":"Chen","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1177\/0194599816646968","article-title":"Endoscopic Resection of Sinonasal Malignancy: A Systematic Review and Meta-analysis","volume":"155","author":"Rawal","year":"2016","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1038\/ncponc0560","article-title":"The Norton-Simon hypothesis: Designing more effective and less toxic chemotherapeutic regimens","volume":"3","author":"Simon","year":"2006","journal-title":"Nat. Clin. Pract. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"106485","DOI":"10.1016\/j.oraloncology.2023.106485","article-title":"Squamous cell carcinoma of the mobile tongue in young adults: A Swedish head & neck cancer register (SweHNCR) population-based analysis of prognosis in relation to age and stage","volume":"144","author":"Jonasson","year":"2023","journal-title":"Oral Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"107443","DOI":"10.1016\/j.oraloncology.2025.107443","article-title":"Predictive value of three comorbidity indices for survival endpoints in oral squamous cell carcinoma","volume":"167","author":"Liu","year":"2025","journal-title":"Oral Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.oraloncology.2019.02.001","article-title":"Survival outcomes after treatment of cancer of the oral cavity (1985\u20132015)","volume":"90","author":"Zanoni","year":"2019","journal-title":"Oral Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"107367","DOI":"10.1016\/j.oraloncology.2025.107367","article-title":"The association between health-related quality of life and five-year overall survival among head and neck cancer patients: A prospective cohort study","volume":"166","author":"Buffart","year":"2025","journal-title":"Oral Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1002\/lary.32064","article-title":"The Evolution of Multidisciplinary Head and Neck Cancer Treatment","volume":"135","author":"Contrera","year":"2025","journal-title":"Laryngoscope"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"107582","DOI":"10.1016\/j.oraloncology.2025.107582","article-title":"The role of systemic therapy in patients with recurrent or metastatic head and neck squamous cell carcinoma progressed to immunotherapy: A systematic review and meta analysis","volume":"168","author":"Tosoni","year":"2025","journal-title":"Oral Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e29642","DOI":"10.2196\/29642","article-title":"Stepwise-Hierarchical Pooled Analysis for Synergistic Interpretation of Meta-analyses Involving Randomized and Observational Studies: Methodology Development","volume":"23","author":"Shin","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"15031","DOI":"10.1073\/pnas.1302997110","article-title":"US studies may overestimate effect sizes in softer research","volume":"110","author":"Fanelli","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"100789","DOI":"10.1016\/j.ssmph.2021.100789","article-title":"Powering population health research: Considerations for plausible and actionable effect sizes","volume":"14","author":"Matthay","year":"2021","journal-title":"SSM Popul. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"095005","DOI":"10.1088\/1361-6560\/ad37ea","article-title":"Comparison of semi-automatic and manual segmentation methods for tumor delineation on head and neck squamous cell carcinoma (HNSCC) positron emission tomography (PET) images","volume":"69","author":"Philip","year":"2024","journal-title":"Phys. Med. Biol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"623","DOI":"10.2967\/jnumed.123.266574","article-title":"Clinical Evaluation of Deep Learning for Tumor Delineation on (18)F-FDG PET\/CT of Head and Neck Cancer","volume":"65","author":"Kovacs","year":"2024","journal-title":"J. Nucl. Med."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/7\/409\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:40:56Z","timestamp":1783608056000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/7\/409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":60,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["curroncol33070409"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33070409","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}