The objective of surgical resection is the annihilation of cancer, both gross and microscopic. Surgeons aspire to strike a balance between functional outcomes and a safe oncological clearance in the intricate head and neck anatomical structures. In spite of wide excision with clear margins, oral cancers tend to recur. A cavalcade of molecular and biological events, such as a tumor microenvironment change, is initiated before the tumor breaches the basement membrane and acquires the silhouette of a non-healing ulcer. The revised "seed and soil" hypothesis considers the seed as the progenitor cell and "soil" as the host factor and tumor microenvironment [1]. Despite being addressed by the treatment, the seed's concurrent subtle changes in the soil conducive to malignant cells remain unaddressed. The cohort of immune cells needs to be vigilant and buttress the host microenvironment to prevent malignant cells from bypassing the immune mechanism. The local recurrence rate in HNSCC is 10%-30%, and the annual risk for a second primary is 3- 4% [2]. The roots of advanced cancers seem to be unscathed by the cut (surgery), burn (radiation), and poison (chemo) therapy. The roots might have enough nutrition to sprout from circulating tumor cells or the residual tumor in case of positive or close margins. There are instances of genomic alterations in free tumor margins that could probably contribute to inferior outcomes [3]. Invasive oral cancers gain access to the perineural and lymphovascular spaces, and all these factors can sway tumor biology. Despite cutting the roots (circumferential wide resection or compartmental resection), it provides a short reprieve as tumor buds sprout with a vengeance due to the multiplanar configuration of cancer. Several other factors include the tumor immune microenvironment and the stroma in which the solid cells reside [4,5]. Field cancerization, accumulation of genetic and epigenetic alterations, micrometastasis, circulating tumor cells, and a battered immune system due to collaterals of chemotherapy serve as conduits for populations of tumor cells. This may explain the detachment of malignant cells that follow a vicious cycle and often recur despite multimodality treatment. The restricted locomotion of the tumor beyond its epicenter contrasts the mechanisms of distant metastasis at advanced presentation observed in solid malignancies. Metastasis is an obstacle to curative therapy and explains approximately 90% of cancer-related deaths. Recurrences in early cancers raise the question of the adequacy of primary surgery, with margins the only factor under the surgeon's command. The other prognostic factors which may water down the significance of free margin are depth of invasion, perineural invasion, lymphovascular space invasion, tumor budding, grade, and immune system. The routes of metastasis may be trans-coelomic, lymphatic, and/or vascular. The outcome of metastasis ultimately rests on the interface and cross-talk between tumor cells and receptive tissues [6].

Therapeutic implications
The concurrent irreversible changes in the tumor microenvironment (soil) cause recurrence irrespective of the seed or the roots of the tumor. The need of the hour is to develop targeted therapy towards the stroma to make the tumor microenvironment more favourable to treatment. Unfavorable precursors in the stroma often precede changes in the epithelium. These must be targeted early with innovative biomolecules and cessation of variables like deleterious habits.