Comparison of the surgical outcomes of free flap reconstruction for primary and recurrent head and neck cancers: a case-controlled propensity score-matched study of 1,791 free flap reconstructions

Kuan-Hua Chen,Spencer C H Kuo,Hsiao-Yun Hsieh,Ching-Hua Hsieh,Peng-Chen Chien

doi:10.1038/s41598-021-82034-5

Kuan-Hua Chen, Spencer C H Kuo + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-82034-5

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Abstract

This study was designed to compare the outcome and analyze the operation-related risk factors in free flap reconstruction for patients with primary and recurrent head and neck cancers. A 1:1 propensity score-matched analysis of the microsurgery registry database of the hospital. The primary outcome of the free flap reconstruction had a higher failure rate in the recurrent group than the primary group (5.1% vs. 3.1%, p = 0.037). Among the 345 pairs in the matched study population, there were no significant differences between the primary and recurrent groups regarding the rate of total flap loss (3.5% vs. 5.5%, p = 0.27) and secondary outcomes. This study revealed that free flap reconstruction had a higher failure rate in the recurrent group than the primary group, but such a difference may be attributed by the different patient characteristics.

Highlights

This study was designed to compare the outcome and analyze the operation-related risk factors in free flap reconstruction for patients with primary and recurrent head and neck cancers
Many efforts have been devoted to clarifying the possible risk factors that were associated with the complications of free flap reconstruction[15,16], exploration of the association of surgical complications with free flap reconstruction in primary or recurrent cancers was rather limited
This study was approved with the reference number 201800440B0 by the institutional review board (IRB) of the Kaohsiung Chang Gung Memorial Hospital, a 2,686-bed medical center located in Kaohsiung city and serves as an important healthcare provider for patients in southern Taiwan[18,19,20]

Summary

Introduction

This study was designed to compare the outcome and analyze the operation-related risk factors in free flap reconstruction for patients with primary and recurrent head and neck cancers. Because the previous surgery would result in scar tissue and possible anatomy changes, chemotherapy and concurrent radiotherapy may cause tissue change in the local region[10,11,12], and the patient’s condition may be more vulnerable to future surgical procedures[13,14,15] These patients with recurrent cancer are expected to have a lower success rate and higher risk of complication than those who undergo their first free flap reconstruction for primary head and neck cancer. Via a selected propensity-score matched population, this study aimed to investigate the outcome of free flap reconstruction following cancer resection for those patients with primary and recurrent head and neck cancer

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