Impact of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction: A systematic review and meta-analysis

Abstract

BackgroundLimited data exists regarding the effect of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction. However, an adequate free flap volume is an important predictor of functional and patient-reported outcomes in head and neck reconstruction. MethodsA systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted using the Preferred Reporting Items for Systematic review and Meta-analyses (PRISMA) guidelines. A total of 6710 abstracts were screened, and 36 full-text papers were reviewed. Nineteen studies met the inclusion criteria and were used to extract data for this analysis. ResultsWe performed a meta-analysis of 14 2-arm studies comparing the impact of adjuvant radiotherapy vs. no adjuvant radiotherapy. The main analysis revealed that, 6 months postoperatively, irradiated flaps showed a significant reduction of volume (average, 9.4%) compared to non-irradiated flaps. The average interpolated pooled flap volumes 6 months postoperatively were 76.4% in irradiated flaps and 81.8% in non-irradiated flaps. After a median postoperative follow-up of 12 months, the total flap volume was 62.6% for irradiated flaps and 76% for non-irradiated flaps. Four studies reported that chemotherapy had no significant impact on free flap volume. ConclusionCompared to non-irradiated flaps, irradiated flaps were significantly reduced in volume (range, 5% to 15.5%). Clinicians should consider this when planning the surgical reconstruction of head and neck defects. Large-scale prospective studies with standardized protocols and well-defined follow-up measurements could help define the ideal, personalized free flap volume for optimal function and patient-reported outcomes.