Comprehensive Analysis of Functional Outcomes and Survival After Microvascular Reconstruction of Glossectomy Defects

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• 作者：Edward I. Chang MD ; Peirong Yu MD ; Roman J. Skoracki MD…
• 刊名：Annals of Surgical Oncology
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：22
• 期：9
• 页码：3061-3069
• 全文大小：2,222 KB
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• 作者单位：Edward I. Chang MD (1)
  Peirong Yu MD (1)
  Roman J. Skoracki MD (1)
  Jun Liu MS (1)
  Matthew M. Hanasono MD (1)
  
  1. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  
• 刊物主题：Surgical Oncology; Oncology; Surgery;
• 出版者：Springer US
• ISSN：1534-4681

文摘

Background Few studies on tongue reconstruction provide a comprehensive, multidisciplinary analysis examining defect size, flap selection, function, and long-term survival. This report presents the largest study in the literature evaluating free flap reconstruction after glossectomy. Methods A retrospective review of patients undergoing free flap glossectomy reconstruction from 2000 to 2012 was performed. Results In this review, 268 patients were identified. Resections involving the tongue only included 59 partial glossectomies, 86 hemiglossectomies, 28 subtotal glossectomies, and 24 total glossectomies. Glossectomies performed with mandibulectomies were analyzed independently for speech and swallowing function (32 partial glossectomies, 18 hemiglossectomies, 8 subtotal glossectomies, and 13 total glossectomies with mandibulectomy). A total of 299 free flaps were performed, with 30 patients receiving two free flaps. Multivariate analysis demonstrating smoking (p?=?0.018), composite resections (p?<?0.001), and larger resections (total and subtotal glossectomies; p?<?0.001) were associated with significantly worse speech results. Advanced age (p?=?0.002), radiation (p?=?0.003), and larger or composite resections had significantly worse swallowing function (p?<?0.001). Patients with a persistent tracheostomy had significantly worse speech and swallowing function (p?<?0.001), whereas innervated flaps were associated with superior speech (p?=?0.049) and better swallowing function (p?=?0.004). The surgical complication rate was 23.5?%, with only one total flap loss. Tumor stage (p?=?0.003), positive margins (p?<?0.001), lymphovascular invasion (p?=?0.023), and chemotherapy (p?<?0.001) were associated with significantly worse overall survival. The median overall survival time was 50.5?months (range 39-9?months). Conclusions Although comorbidities and the extent of resection impair both speech and swallowing, reconstruction, particularly with innervated free flaps, still affords the majority of patients-reasonable function.