PP059: Comparative study of locoregional flaps and free flaps in reconstruction after resection of oral cavity cancer: A cost analysis

Abstract

Purpose Free flaps have proved to be superior in both functionality and aesthetics in front of classical treatment with locoregional flaps in the treatment of patients with large tumors in the oral cavity. The aim of the present study is to assess if free-flap reconstruction is an economically profitable option. Material and methods The present study was based on a retrospective cohort of 60 patients. Of the 60 patients, 30 underwent surgical reconstruction with microvascular tissue transfer and in 30 only local or regional flaps were used. The 6 months of which the overall management costs according to the hospital perspective were calculated were divided into three periods: operative period, the postoperative phase, follow-up during first 6 months. The following outcome variables were analyzed: operative time; blood loss; admission length, including intensive care unit; complications; secondary interventions; readmissions; and feeding status. Cumulative costs were calculated. Statistical analysis was applied. Results Total estimated costs within the first 6 month were comparable in both. The lower costs of hospital admission in the postoperative phase outweighed the higher costs of the surgical procedure in free flap group when compared with local flaps patients. Conclusions In experienced centers, the reconstruction using free flaps in patients treated for tumors of the oral cavity is safe, improves patient quality of life and is economically sustainable. Forty patients who underwent immediate free radial forearm flap reconstruction for oral or oropharyngeal soft tissue defects were matched with patients who underwent pectoralis major myocutaneous flap reconstruction for similar defects. The 2 years of which the overall management costs according to the hospital perspective were calculated were divided into four periods: operative period, the postoperative phase, follow-up during first year and follow-up during second year after discharge. Results The total costs within the first 2 years were comparable at approximately 50,000 Euros. The lower costs of hospital admission (24 days versus 28 days; P = 0.005) in the postoperative phase outweighed the higher costs of the surgical procedure (692 min versus 462 min; P Conclusions Oral and oropharyngeal reconstruction with radial forearm flap is not more costly than pectoralis major flap reconstruction. Given the better functional outcome and the present cost analysis, reconstruction of oral and oropharyngeal defects is preferably performed using free tissue transfer.