Oropharyngeal Reconstruction for Advanced Cancer

Abstract

Objective To assess perioperative morbidity, functional outcomes, and survival following microvascular and regional flap reconstruction of the oropharynx after advanced oncologic resection. Methods 65 patients underwent oropharyngeal reconstruction for late stage primary (35.4%), second primary (10.8%), or recurrent (53.8%) oropharyngeal and oral cavity squamous cell carcinoma at a tertiary cancer center between 1997 and 2007. 50 (76.9%) males and 15 (23.1%) females with a median age of 59.2 years (range 28.6 to 76.1 years) were reconstructed with rectus myocutaneous free flaps (30.8%), anterolateral thigh free flaps (27.7%), radial forearm free flaps (20%), pectoralis myocutaneous pedicled flaps (15.4%), and fibula osseocutaneous free flaps (6.2%). Results The median follow-up time following oropharyngeal reconstruction was 36.3 months (range 1.3 to 144.2 months). There were no complete flap failures and only 1 partial flap failure. 32 (49.2%) patients experienced postoperative complications including 11 wound infections/dehiscences, 7 fistulas, 7 donor site complications, and 11 postoperative pneumonias. Mean intensive care unit nights and total days hospitalized were 2.8 and 9.6, respectively. Of 56 patients undergoing a tracheostomy, 48 (73.8%) were decannulated a median of 13 days (range 5 to 426 days) following surgery. 42 (64.7%) remained at least partially feeding tube-dependent, but 41 (63.1%) attained at least 80% oral speech intelligibility. 3-and 5-year overall survivals following reconstruction were 49.1% and 37.3%, respectively. Conclusions Selected patients who undergo reconstruction for extensive oropharyngeal defects following surgery for advanced cancer can attain long-term survival. While most patients achieve decannulation and functional speech, almost 2/3rds remain feeding tube-dependent.