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Which oral cancer patients benefit the most from microsurgical reconstruction?

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Abstract

The objective of this study is to evaluate the impact of microsurgical reconstruction on local recurrence rates and disease-specific survival in patients with oral squamous cell carcinoma. This study is a retrospective review of patients treated at a tertiary cancer center. Six hundred and five patients were included in this study with 529 males (87.44%) and 76 females (12.56%). These were composed of 467 (77.19%) pedicled-flaps reconstructions and 138 (22.81%) free-flap procedures. There was no difference between the groups regarding T stage, N stage, or type of oncological surgery. Use of postoperative radiotherapy was more common in the free-flap group with a significantly shorter time interval than the pedicled-flap group. Free-flap patients had a lower proportion of compromised/close surgical margins (p < 0.0001). Univariate analysis disclosed as significant for local recurrence: gender, T stage, microsurgical reconstruction, lymphatic embolization, neural infiltration, and surgical margins. In a multivariate model, T stage (p < 0.001), neural infiltration (p < 0.001), and microsurgical reconstruction (p < 0.001) remained significant. Significant factors for survival in univariate analysis were: gender, T stage, N stage, synchronous neck dissection, microsurgical reconstruction, lymphatic embolization, neural infiltration, and surgical margins. In a multivariate analysis, T stage (p < 0.001), N stage (p < 0.001), synchronous neck dissection (p = 0.025), microsurgical reconstruction (p < 0.001), lymphatic embolization (p = 0.023), and neural infiltration (p < 0.001) remained significant. Regression trees show a significant impact of free flaps in T3/T4 primary tumors. Use of microsurgical flaps provides a significant improvement in local recurrence and survival in patients with T3–T4a primary tumors. It also reduces the interval between surgery and radiotherapy.

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Conflict of interest

The authors have no conflict of interest or financial support to disclose.

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Authors and Affiliations

  1. Department of Head and Neck Surgery and Otolaryngology, Hospital A C Camargo, São Paulo, Brazil

    Mônica Lúcia Rodrigues, José Magrin, Alexsander Bressan, José Carlos Marques de Faria & Luiz Paulo Kowalski

  2. Department of Otolaryngology, State University of Campinas, São Paulo, Brazil

    Hugo Fontan Köhler

  3. Departamento de Otorrinolaringologia e Cabeça e Pescoço, Caixa Postal 6111, CEP 13081-970, Campinas, São Paulo, Brazil

    Hugo Fontan Köhler

Authors
  1. Mônica Lúcia Rodrigues
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  2. Hugo Fontan Köhler
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  3. José Magrin
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  4. Alexsander Bressan
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  5. José Carlos Marques de Faria
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  6. Luiz Paulo Kowalski
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Correspondence to Hugo Fontan Köhler.

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Rodrigues, M.L., Köhler, H.F., Magrin, J. et al. Which oral cancer patients benefit the most from microsurgical reconstruction?. Eur J Plast Surg 34, 75–80 (2011). https://doi.org/10.1007/s00238-010-0462-0

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  • DOI: https://doi.org/10.1007/s00238-010-0462-0

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