Predictors and impact of microsurgical complications in patients with locally advanced oral squamous cell carcinoma.
Microvascular free flap transfer for post-oncologic reconstructive surgery in oral cancer is considered to be a challenge due to the complexity of the anatomy and function of the region. We sought to identify possible factors associated with microsurgical complications and to assess the impact of these complications in relation to patient survival. Following the inclusion and exclusion protocol, 142 patients with stage III and IV oral squamous cell carcinoma (OSCC) who underwent immediate free flap reconstruction after tumor ablation were included in the study. Clinical and surgical procedural-related factors were retrieved from a database and analyzed retrospectively; survival data were evaluated using the Kaplan-Meier method. Major complications that required re-anastomosis of the flap vessels occurred in 23 patients (16.2%); total necrosis of the flaps, regardless of salvage treatment, occurred in seven cases, with 95.1% of full flap survival. The American Society of Anesthesiologists classification, types of neck dissection, and number of flaps were regarded as strong predictors for surgical complications. Patients with these complications appeared to have a shortened survival (5-year cancer-specific survival of approximately 60%, both in stage III and IV OSCC). However, the impact of surgical complications on survival was significant only in stage III OSCC (P = 0.037). Strategies to minimize surgical complications should be used to ensure better prognoses for these patients.
Division of Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taiwan.
Ya-Wei
YW
Chen
Chia-Yu
CY
Chen
Shu-Chiung
SC
Chiang
Man-Tin
MT
Lui
Shou-Yen
SY
Kao
Muh-Hwa
MH
Yang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors