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Comprehensive Analysis of Functional Outcomes and Survival After Microvascular Reconstruction of Glossectomy Defects

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Few studies on tongue reconstruction provide a comprehensive, multidisciplinary analysis examining defect size, flap selection, function, and long-term survival. This report presents the largest study in the literature evaluating free flap reconstruction after glossectomy.

Methods

A retrospective review of patients undergoing free flap glossectomy reconstruction from 2000 to 2012 was performed.

Results

In this review, 268 patients were identified. Resections involving the tongue only included 59 partial glossectomies, 86 hemiglossectomies, 28 subtotal glossectomies, and 24 total glossectomies. Glossectomies performed with mandibulectomies were analyzed independently for speech and swallowing function (32 partial glossectomies, 18 hemiglossectomies, 8 subtotal glossectomies, and 13 total glossectomies with mandibulectomy). A total of 299 free flaps were performed, with 30 patients receiving two free flaps. Multivariate analysis demonstrating smoking (p = 0.018), composite resections (p < 0.001), and larger resections (total and subtotal glossectomies; p < 0.001) were associated with significantly worse speech results. Advanced age (p = 0.002), radiation (p = 0.003), and larger or composite resections had significantly worse swallowing function (p < 0.001). Patients with a persistent tracheostomy had significantly worse speech and swallowing function (p < 0.001), whereas innervated flaps were associated with superior speech (p = 0.049) and better swallowing function (p = 0.004). The surgical complication rate was 23.5 %, with only one total flap loss. Tumor stage (p = 0.003), positive margins (p < 0.001), lymphovascular invasion (p = 0.023), and chemotherapy (p < 0.001) were associated with significantly worse overall survival. The median overall survival time was 50.5 months (range 39–79 months).

Conclusions

Although comorbidities and the extent of resection impair both speech and swallowing, reconstruction, particularly with innervated free flaps, still affords the majority of patients’ reasonable function.

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Disclosure

The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this manuscript. No funding was received for the work presented in this manuscript.

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Authors and Affiliations

  1. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Edward I. Chang MD, Peirong Yu MD, Roman J. Skoracki MD, Jun Liu MS & Matthew M. Hanasono MD

Authors
  1. Edward I. Chang MD
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  2. Peirong Yu MD
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  3. Roman J. Skoracki MD
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  4. Jun Liu MS
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  5. Matthew M. Hanasono MD
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Correspondence to Edward I. Chang MD.

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Chang, E.I., Yu, P., Skoracki, R.J. et al. Comprehensive Analysis of Functional Outcomes and Survival After Microvascular Reconstruction of Glossectomy Defects. Ann Surg Oncol 22, 3061–3069 (2015). https://doi.org/10.1245/s10434-015-4386-6

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  • DOI: https://doi.org/10.1245/s10434-015-4386-6

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