Mücke, T; Wolff, KD; Wagenpfeil, S; Mitchell, DA; Hölzle, F
Immediate microsurgical reconstruction after tumor ablation predicts survival among patients with head and neck carcinoma.
BACKGROUND: The purpose of this study was to examine whether or not immediate microvascular free flap reconstruction influences survival among treated patients suffering from oral squamous cell carcinoma (OSCC), controlling for demographic, clinical, and tumor characteristics. METHODS: 773 patients with OSCC were treated with curative intent. Two hundred and seventy-four patients were immediately reconstructed using free microsurgical flaps. All measures were collected by chart abstraction. Kaplan-Meier plots and univariate log-rank test and multivariate Cox proportional hazards regression models were used to determine the association between possible predictor variables and survival time. In addition, a randomized matched-pair analysis was conducted to compensate different patient cohorts. RESULTS: After controlling for age, tumor stage, nodal stage, and tumor grade, which were independent and dependent predictors of survival, microsurgical free flap reconstruction was associated with survival [hazard ratio(HR) = 0.66, P< 0.001, 95% confidence interval (CI), 0.52 to 0.83]. In the randomized matched-pair analysis this effect became more evident (HR = 0.58, P< 0.001, 95% CI, 0.44 to 0.75). Controlling for extent of tumor, only T3 and T4 tumors were significantly associated with survival (P< 0.001, HR = 0.46, 95% CI, 0.31 to 0.69) when the area of defect was reconstructed, whereas in T1 and T2 tumors no significance was noted (P = 0.08, HR = 0.74, 95% CI, 0.53 to 1.04). CONCLUSIONS: Reconstruction of defects, especially in patients presenting with higher tumor stages, is not associated with shorter overall survival rates, as revealed in this study, and should be considered when functional deficits due to tumor ablation can be expected postoperatively.