This investigation reveals a notable increase in survival rates over time. Being treated in the last decade has proven to be an independently favorable factor, as shown by multivariate analysis. Notably, the recent period saw more early-stage cases treated, but a stage-stratified analysis indicates significant benefits for advanced-stage patients. In early-stage OSCCs, surgical resection is more straightforward, often easily achievable with a 1.5-cm margin from the tumor. Consequently, the benefits of technological advancements, significant in enhancing survival rates in advanced stages, might have a comparatively modest effect in this particular subgroup.

While other researches have demonstrated improved survival rates in oral cavity cancer in the last decade, these findings predominantly stem from multi-institutional cancer registry data [21,22,23]. Such large-scale studies, while valuable, often face challenges like heterogeneity of data sources, limited access to detailed clinical information, and variability in patient follow-up procedures. Our mono-institutional study addresses these issues by providing a more controlled, detailed, and consistent dataset, allowing for directly associate the observed improvements in survival with the implementation of advanced diagnostic and therapeutic techniques specific to our institution. The same surgeon and team of pathologists and radiologists managed patients throughout our series, ensuring consistency in surgical approach and diagnostic and postoperative evaluations. Furthermore, the follow-up strategies employed were stringent and uniform across all cases, ensuring a consistent monitoring approach.

The observation that the improvement in survival rates among patients with OSCC has been linked to increased use of innovative diagnostic techniques is noteworthy. Techniques like NBI have been increasingly utilized not only in the diagnostic phase, but also during surgical procedures. The use of FS has also become recently more common. Additionally, the MCC discussion of clinical cases, involving experts from various fields, has become a vital part of the treatment process. While these advancements are associated with better survival outcomes, it is important to clarify that this is an association rather than a direct cause-and-effect relationship. The complexity of cancer treatment means that many factors contribute to patient outcomes, and while these innovative techniques are certainly beneficial, they are part of a broader array of factors influencing patient survival.

NBI usage potentially improves diagnostic accuracy before treatment and defines surgical margins more precisely during operations [5, 24], possibly leading to more effective cancer removal while preserving vital healthy tissue, crucial for patient recovery and reducing recurrence [7].

Additionally, the use of FS may have significantly contributed to accurately assessing surgical excision completeness. Its real-time feedback allows surgeons to adjust removal during the procedure, potentially achieving complete tumor removal in one surgery. Recent trends, such as the ‘defect-driven margin mapping’ with the ‘strip-and-bowl’ technique, further enhance margin assessment and tumor removal precision [15]. This approach not only improves surgical precision but also reduces the need for additional surgeries, potentially improving patient outcomes [21].

Also, we noted a significant trend in the use of the CO2 waveguide laser, exclusively observed in recent periods. This preference is due to its superior efficacy compared to other non-conventional cutting tools, showing reduced thermal damage and improved FS readability [18, 25]. These factors may improve surgical radicality and define surgical margins more accurately [25]. Additionally, the laser’s distinct interaction with healthy mucosa or cancer aids in determining tumor depth extension [8, 18].

The increase in the discussion of clinical cases within MCC in the recent period is significant and may have contributed to improved survival rates. A recent meta-analysis has shown that patients managed by MCCs exhibited increased OS compared to control patients [26], indicating that a collaborative approach among diverse specialists positively impacts patient outcomes.

It is also noteworthy that such improvements have occurred despite a reduced reliance on open surgery and en bloc resection. While open surgery and en bloc resection have been traditional methods, their associated morbidity and impact on quality of life have prompted a shift toward more conservative approaches. These methods can help achieve adequate tumor removal while preserving as much healthy tissue as possible, reducing the need for complex free flap reconstructions.

In particular, some authors advocate the en bloc approach for treating T2-T3 cancers, citing the presence of the T-N tract as justification. This tract is defined as all anatomical structures located between the tongue (T) and the first nodal level (N). It encompasses the sublingual and submandibular glands, the mylohyoid muscles, the lingual arteries, veins, and nerves, the hypoglossal nerves, the Wharton ducts, the lingual and sublingual nodes, and stromal tissue. [27]. In our recent clinical experience, the decisive factor in approach selection has been the invasion of the mylohyoid muscle, serving as a vital barrier between the oral cavity and neck compartments. When MRI confirms muscle invasion, we opt for compartmental surgery and utilize a free flap. On the other hand, if MRI does not definitively indicate muscle invasion, an intraoperative FS assessing potential infiltration up to the mylohyoid muscle allows us to convert the transoral approach to a compartmental approach. [25]

The analysis of QoL revealed several more favorable scores in patients treated in the most recent period, even after stratifying by stage. Specifically, pain scores six months post-treatment were more favorable in the recent group. This suggests that changes in diagnostic and therapeutic strategies may have positively impacted not only prognosis, but also this aspect of QoL. However, recent trends indicate rising expectations and demands from head and neck cancer patients [28], potentially obscuring the true extent of QoL improvements across different patient groups.

The present study has several limitations that warrant attention. First and foremost, its retrospective cohort design inherently imposes limitations, as it relies on historical data that may lack certain relevant information and are subject to selection bias. Additionally, while our single-center study allowed for a controlled and consistent dataset, future multicenter studies could provide a broader perspective, larger sample size, and increased generalizability of the findings across different healthcare settings and populations. Also, the follow-up period, though extended, might not be sufficient to fully assess long-term outcomes, particularly for QoL, which can vary significantly over time. Additionally, the QoL assessment was only conducted six months post-treatment, a time frame that might not fully reflect the patients’ experiences throughout their recovery and rehabilitation. Lastly, it is crucial to consider that the study’s conclusions are based on associative observations and do not provide direct evidence of causality. While technological advancements and multidisciplinary treatment strategies may be associated with improved outcomes, other unassessed factors in the study could significantly impact patient outcomes. This underscores the need for further research to better understand the impact of these evolving strategies and technologies on oral cancer prognosis.