title: Primary radical ablative surgery and fibula free-flap reconstruction for T4 oral cavity squamous cell carcinoma with mandibular invasion: oncologic and functional results and their predictive factors.
abstract: The aims of this study were to evaluate clinical outcomes and to determine their predictive factors in patients with oral cavity squamous cell carcinoma (OCSCC) invading the mandibular bone (T4) who underwent primary radical surgery and fibula free-flap reconstruction. Between 2001 and 2013, all patients who underwent primary surgery and mandibular fibula free-flap reconstruction for OCSCC were enrolled in this retrospective study. Predictive factors of oncologic and functional outcomes were assessed in univariate and multivariate analysis. 77 patients (55 men and 22 women, mean age 62 ± 10.6 years) were enrolled in this study. Free-flap failure and local and general complication rates were 9, 31, and 22 %, respectively. In multivariate analysis, ASA score (p = 0.002), pathologic N-stage (p = 0.01), and close surgical margins (p = 0.03) were independent predictors of overall survival. Six months after therapy, oral diet, speech intelligibility, and mouth opening functions were normal or slightly impaired in, respectively, 79, 88, and 83 % of patients. 6.5 % of patients remaining dependent on enteral nutrition 6 months after therapy. With acceptable postoperative outcomes and satisfactory oncologic and functional results, segmental mandibulectomy with fibula free-flap reconstruction should be considered the gold standard primary treatment for patients with OCSCC invading mandible bone. Oncologic outcomes are dependent on three main factors: ASA score, pathologic N-stage, and surgical margin status.
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Camuzard
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dassonville
authors.affiliation: Department of Statistics, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Ettaiche
authors.affiliation: Department of Statistics, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chamorey
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Poissonnet
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France.
authors.forename: Riadh
authors.initials: R
authors.lastname: Berguiga
authors.affiliation: Department of Radiotherapy, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Axel
authors.initials: A
authors.lastname: Leysalle
authors.affiliation: Department of Radiotherapy, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Karen
authors.initials: K
authors.lastname: Benezery
authors.affiliation: Department of Medical Oncology, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Peyrade
authors.affiliation: Department of Medical Oncology, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Esma
authors.initials: E
authors.lastname: Saada
authors.affiliation: Department of Anaesthesia and Reanimation, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Hechema
authors.affiliation: Department of Pathology, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Sudaka
authors.affiliation: Department of Pathology, Antoine Lacassagne Center, 33 Avenue de Valombrose, 06189, Nice, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Haudebourg
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France.
authors.forename: François
authors.initials: F
authors.lastname: Demard
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France.
authors.forename: José
authors.initials: J
authors.lastname: Santini
authors.affiliation: Face and Neck University Institute, 31 Avenue de Valombrose, 06103, Nice, France. alexandre.bozec@nice.unicancer.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bozec
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps; D006085:Graft Survival; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D000072662:Margins of Excision; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies
keywords: Fibula; Free-flap; Head neck cancer; Mandible; Oral cavity; Reconstruction