Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Sequential reconstruction for recurrent head and neck cancer: A 10-year experience

  • Chung, Soon Won (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Byun, Il Hwan (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Lee, Won Jai (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine)
  • Received : 2019.01.25
  • Accepted : 2019.07.26
  • Published : 2019.09.15
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Abstract

Background Most patients with head and neck cancer successfully undergo oncologic resection followed by free or local flap reconstruction, depending on the tumor's size and location. Despite effective curative resection and reconstruction, head and neck cancer patients still face a high risk of recurrence and the possibility of a second primary cancer. Moreover, surgeons hesitate to perform sequential reconstruction following curative resection for several reasons. Few large-scale studies on this subject are available. Therefore, we retrospectively evaluated the outcome of sequential head and neck reconstruction to determine the possible risks. Methods In total, 467 patients underwent head and neck reconstruction following cancer resection at our center from 2008 to 2017. Of these cases, we retrospectively reviewed the demographic and clinical features of 58 who had sequential head and neck reconstruction following resection of recurrent cancer. Results Our study included 43 males (74.1%) and 15 females (25.9%). The mean age at the initial operation was $55.4{\pm}15.3years$, while the mean age at the most recent operation was $59.0{\pm}14.3years$. The interval between the first and second operations was $49.2{\pm}62.4months$. Twelve patients (20.7%) underwent surgery on the tongue, and 12 (20.7%) had procedures on the oropharynx. Thirty-four patients (58.6%) received a sequential free flap reconstruction, and 24 patients (41.4%) were treated using locoregional flaps. No cases of flap failure occurred. Conclusions Our findings suggest that patients who need additional operations with recurrent head and neck cancer could optimally benefit from sequential curative resections and reconstructions.

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References

  1. Cooper JS, Porter K, Mallin K, et al. National Cancer Database report on cancer of the head and neck: 10-year update. Head Neck 2009;31:748-58. https://doi.org/10.1002/hed.21022
  2. Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction: report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg 1994;120:633-40. https://doi.org/10.1001/archotol.1994.01880300047007
  3. Kroll SS, Evans GR, Goldberg D, et al. A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg 1997;99:1282-6. https://doi.org/10.1097/00006534-199704001-00011
  4. Varvares MA, Lin D, Hadlock T, et al. Success of multiple, sequential, free tissue transfers to the head and neck. Laryngoscope 2005;115:101-4. https://doi.org/10.1097/01.mlg.0000150697.54000.eb
  5. Vermorken JB, Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol 2010;21 Suppl 7:vii252-61. https://doi.org/10.1093/annonc/mdq196
  6. Chen W, Yang Z, Zhang D, et al. Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma. Int J Oral Maxillofac Surg 2014;43:531-8. https://doi.org/10.1016/j.ijom.2013.11.011
  7. Gupta AK, McKenna WG, Weber CN, et al. Local recurrence in head and neck cancer: relationship to radiation resistance and signal transduction. Clin Cancer Res 2002;8: 885-92.
  8. Demirkan F, Wei FC, Chen HC, et al. Microsurgical reconstruction in recurrent oral cancer: use of a second free flap in the same patient. Plast Reconstr Surg 1999;103:829-38. https://doi.org/10.1097/00006534-199903000-00008
  9. Forastiere A, Koch W, Trotti A, et al. Head and neck cancer. N Engl J Med 2001;345:1890-900. https://doi.org/10.1056/NEJMra001375
  10. Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009;29:1-7. https://doi.org/10.1002/micr.20560
  11. Avery CM, Crank ST, Neal CP, et al. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010;46:829-33. https://doi.org/10.1016/j.oraloncology.2010.08.004
  12. Kekatpure VD, Trivedi NP, Manjula BV, et al. Pectoralis major flap for head and neck reconstruction in era of free flaps. Int J Oral Maxillofac Surg 2012;41:453-7. https://doi.org/10.1016/j.ijom.2011.12.029
  13. Avery CM, Gandhi N, Peel D, et al. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit. Int J Oral Maxillofac Surg 2014;43:546-54. https://doi.org/10.1016/j.ijom.2013.10.009
  14. Chen WL, Li J, Yang Z, et al. Extended vertical lower trapezius island myocutaneous flap in reconstruction of oral and maxillofacial defects after salvage surgery for recurrent oral carcinoma. J Oral Maxillofac Surg 2007;65:205-11. https://doi.org/10.1016/j.joms.2005.10.056
  15. Ali RS, Bluebond-Langner R, Rodriguez ED, et al. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009;124(6 Suppl):e395-407. https://doi.org/10.1097/PRS.0b013e3181bcf05c
  16. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap?: an experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109:2219-26. https://doi.org/10.1097/00006534-200206000-00007
  17. Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004;57:603-9. https://doi.org/10.1016/j.bjps.2004.05.032
  18. Nakayama B, Kamei Y, Toriyama K, et al. Usefulness of a first transferred free flap vascular pedicle for secondary microvascular reconstruction in the head and neck. Plast Reconstr Surg 2002;109:1246-53. https://doi.org/10.1097/00006534-200204010-00006
  19. Offodile AC 2nd, Chang KP, Chen HH, et al. Feasibility and outcomes of the third or more episodes of sequential microvascular reconstruction for recurrent or second primary oral cancer. Ann Surg Oncol 2016;23:3765-72. https://doi.org/10.1245/s10434-016-5283-3
  20. Hanasono MM, Corbitt CA, Yu P, et al. Success of sequential free flaps in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2014;67:1186-93. https://doi.org/10.1016/j.bjps.2014.05.012
  21. Tsue TT, Desyatnikova SS, Deleyiannis FW, et al. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx: free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg 1997;123:731-7. https://doi.org/10.1001/archotol.1997.01900070075012
  22. Chepeha DB, Annich G, Pynnonen MA, et al. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg 2004;130: 181-6. https://doi.org/10.1001/archotol.130.2.181
  23. Hanasono MM, Friel MT, Klem C, et al. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head Neck 2009;31:1289-96. https://doi.org/10.1002/hed.21100

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