Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction

Chen, Diane W.; Wang, Tao; Ni, Jonathan; Sandulache, Vlad C.; Graboyes, Evan M.; Hornig, Joshua D.; Skoner, Judith M.; Day, Terry A.; Huang, Andrew T.

doi:10.1016/j.oraloncology.2019.03.005

Cited by 24 publications

(27 citation statements)

References 43 publications

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“…Head and neck radiation contributes to functional complications like dysgeusia, dysphasia, and trismus 16,17 . Specifically, adjuvant radiation after free flap reconstruction contributes to swallowing dysfunction and inadequate oral intake 18 . Our results shed light upon another area of concern in these patients: radiation treatment‐associated aesthetic deficits.…”

Section: Discussionmentioning

confidence: 73%

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

et al. 2021

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Objectives/Hypothesis To better understand aesthetic patient‐reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. Study Design Single‐center prospectively obtained in‐office validated questionnaire‐based study. Methods Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE‐Q scales: Appearance‐Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. Results One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2–30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4–24.4, P = .019) and 10.4% lower SF (95% CI: −20.7 to −0.1, P = .047). Each appearance‐related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. Conclusions Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. Level of Evidence 3 Laryngoscope, 131:E2204–E2211, 2021

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Section: Discussionmentioning

confidence: 73%

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

et al. 2021

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“…After approval from the institutional review boards of Baylor College of Medicine (Houston, TX) and Medical University of South Carolina (Charleston, SC), the medical records of adult patients who underwent STL with MVFTT after primary radiation with or without chemotherapy from January 2010 to April 2019 for oncologic or palliative purposes were reviewed. Our institutions maintain de‐identified patient databases of MVFTT outcomes with results published in the literature on elderly, laryngectomy, and oral cavity reconstruction swallowing outcomes 14–17 . Only patients who underwent patched or tubed MVFTT reconstruction of the pharyngoesophagus were included, excluding those who had primary pharyngeal closure with muscle overlay MVFTT.…”

Section: Methodsmentioning

confidence: 99%

Free Flap Inset Techniques in Salvage Laryngopharyngectomy Repair: Impact on Fistula Formation and Function

et al. 2020

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Objective To characterize pharyngocutaneous fistula (PCF) rates and functional outcomes following microvascular free tissue transfer (MVFTT) reconstruction of salvage total laryngectomy (STL) with a review of two different flap inset techniques and a review of the literature. Methods Retrospective review. Results Review of the literature revealed 887 patients who underwent STL MVFTT from 14 references. Ninety‐six STL MVFTTs were performed by the authors, with 36 (38%) patients undergoing multilayer fascial underlay (MLFU) closure and 60 (62%) a standard single layer closure (SLC). One (3%) PCF occurred in the MLFU group compared to 12 (20%) in the SLC cohort (P = .03). Postoperative gastrostomy (G)‐tube dependence was lower following MLFU closure compared to SLC (25% vs. 57%, P < .01), whereas pharyngoesophageal stricture (PES) (28% vs. 38%), tracheoesophageal puncture (TEP) placement (42% vs. 42%), and TEP usage (87% vs. 88%) did not significantly differ (P > .05). Compared to pooled rates from the literature, patients who underwent a MLFU MVFTT inset technique demonstrated significantly lower PCF incidence (3% vs. 23%, P < .01) without significant differences in PES (28% vs 23%, P = .55), G‐tube dependence (25% vs. 23%, P = .25), or TEP placement (42% vs. 59%, P = .09). Conclusion Despite MVFTT reconstruction after STL, G‐tube dependence, PCF formation, and limitations of speaking rehabilitation (TEP) remain a significant issue. Modification of MVFTT inset may provide an opportunity to reduce PCF incidence without affecting other functional outcomes. Level of Evidence 4 Laryngoscope, 131:E875–E881, 2021

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“…Em estudo com pacientes submetidos à glossectomia parcial, subtotal ou total, verificou que a VO foi conseguida por 49% dos participantes, enquanto 16% eram parcialmente dependentes da via alternativa de alimentação e 36% eram totalmente dependentes da via enteral para nutrição. Nos pacientes que conseguiram VO, a média do tempo foi de 31 dias (variando de 9 -209 dias) (23) . No presente estudo, a frequência da liberação da VO maior e em menor tempo, provavelmente deve-se a ausência de casos de glossectomia total ou subtotal.…”

Section: Discussionunclassified

Análise do tempo de decanulação e liberação de via oral em pacientes com câncer de boca

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Vicente

Gama

2021

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RESUMO Objetivo caracterizar o tempo de decanulação e liberação de dieta por via oral dos pacientes submetidos à cirurgia do câncer de boca no Hospital Alberto Cavalcante, e verificar quais fatores estão associados ao atraso no tempo de decanulação e de liberação de dieta por via oral. Método estudo observacional de análise do banco de dados de 33 pacientes adultos tratados cirurgicamente do câncer de boca e atendidos no período de 2012 a 2017. As variáveis sociodemográficas (idade e sexo) e clínicas (tipo de cirurgia, extensão operatória, tipo de reconstrução, condições clínicas e tempos de decanulação e reintrodução da via oral) foram coletadas por meio de análise de prontuários eletrônicos. Foi realizada análise estatística descritiva com medidas de tendência central, dispersão e proporções. Para análise de associação foi utilizado o teste não paramétrico Mann-Whitney para amostras independentes. Resultados Dos 33 participantes, predominou o sexo masculino e idosos, 69,8% realizaram ressecção de mais de uma estrutura. A mediana do tempo de decanulação entre os pacientes com câncer de boca foi de 8 dias, e da liberação da via oral foi de 9,5 dias. As ressecções com mais de uma estrutura, a presença de fístula e de deiscência interferiram no tempo de liberação de via oral. Conclusão a mediana de tempo de decanulação foi de oito dias e de liberação de via oral de 9,5 dias. As ressecções com mais de uma estrutura, a presença de fístula, e de deiscência de sutura, estão associadas com o aumento do tempo de liberação de via oral.

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Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction

Cited by 24 publications

References 43 publications

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

Free Flap Inset Techniques in Salvage Laryngopharyngectomy Repair: Impact on Fistula Formation and Function

Análise do tempo de decanulação e liberação de via oral em pacientes com câncer de boca

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