AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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The Impact of Reconstructive Microsurgery in Patients With Advanced Oral Cavity Cancers
Matthew M. Hanasono, M.D., Michael Friel, M.D., Christopher Klem, M.D., Patrick Hsu, M.D., Randal S. Weber, M.D., David W. Chang, M.D..
The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.

Purpose: To determine the impact of reconstructive microsurgery on the oncologic and functional outcomes of patients treated for advanced oral cavity cancers.
Methods: A review of 529 patients undergoing resection of T3-4 oral cavity cancers from 1980 to 2004 at The University of Texas M. D. Anderson Cancer Center was undertaken. A comparison 114 patients treated prior to the introduction of microvascular free flap surgery (1980-1987) and 415 patients treated after the introduction of microvascular free flap surgery (1988-2004) was performed to examine how the availability of free flap reconstruction affected patient outcomes.
Results: There were no significant differences in the age, tobacco or alcohol use, proportion of recurrent/residual cancers, or the distribution of oral cavity cancer sites. Cancers treated after the introduction of free flaps included a significantly higher proportion of T4 compared to T3 lesions (69.2% vs. 36.9% T3 and 30.8% vs. 63.1% T4, before and after free flaps were introduced, respectively; P<0.000001) and significantly more advanced N stage lesions (22.0% vs. 37.7% with N2-3 disease compared to N0-1 disease; P<0.0005). Significantly more patients received pre- or postoperative radiation therapy after the introduction of free flaps (53.4% vs. 69.8%, P<0.0005).
A total of 55 nonmicrovascular reconstructions were performed from 1980 to 1988. A total of 115 nonmicrovascular reconstructions, and 258 free flap reconstructions were performed from 1988 to 2004. In both cases, the remaining patients were reconstructed by primary closure or did not undergo reconstruction. The free flap survival rate was 97.7%.
The rate of fistula formation (15.1% vs. 8.9%; P<0.05) decreased after the introduction of free flaps. Other complications generally occurred at similar rates. Extended hospital stays (greater than 11 days) decreased after the introduction of free flaps (62.6% vs. 35.8%; P<0.00001). In both groups, the majority of patients received a tracheostomy at the time of surgery (80.0% vs. 74.7%; P=NS). The proportion of patients successfully decannulated significantly increased after the introduction of free flaps (80.9% vs. 93.1%, P<0.0005). In both groups, the majority of patients received a feeding tube at the time of surgery (87.1% vs. 83.7%; P=NS). While the proportion of patients who were able to resume a regular diet increased after the introduction of free flaps (20.8% vs. 36.7%, P<0.05), the proportion of patients that were achieved feeding tube-independence decreased (81.9% vs. 63.3%, P<0.005). The proportion of patients who had intelligible speech (communicated by spoken word alone) increased after the free flap introduction (51.8% vs. 78.5%, P<0.00001). Survival and time to cancer recurrence did not change significantly after the introduction of free flaps, although the cancers treated during this time were more advanced.
Conclusions: Concomitant with other changes in treatment, we treated significantly more advanced oral cavity cancers after the introduction of microvascular free flap surgery at our institution with similar rates of survival and disease free intervals as had been observed previously. The rate of fistula formation decreased and hospitalization times became shorter. Functionally, patients were found to have a higher likelihood of decannulation, achieving a regular diet, and regaining intelligible speech.


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