Feasibility and Outcomes of the Third or More Episodes of Sequential Microvascular Reconstruction for Recurrent or Second Primary Oral Cancer

Chang, Kai Ping; Chen, Hsin Hung; Loesch, Eric; Hung, Shao Yu; Kao, Huang Kai

doi:10.1245/s10434-016-5283-3

Cited by 13 publications

(12 citation statements)

References 29 publications

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“…The flap success rate for all patients was 94.4%. This success rate is lower when compared with studies investigating surgical outcomes of first or second reconstructions, but comparable with other studies looking at third or more reconstructions 7 , 9 , 10 . The decline in flap success rate in cases with multiple previous reconstructions is multifactorial.…”

Section: Discussionsupporting

confidence: 75%

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Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Löfstrand

Chang

Lin

et al. 2017

Sci Rep

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Performing a sequential third free flap for reconstruction of a head and neck defect after cancer resection can be challenging, and the problem is further compounded in elderly patients. The outcomes in this clinical scenario are currently unknown and this study aims to compare the results in elderly patients with younger patients in a high-volume microsurgical unit. A retrospective review of 126 consecutive patients who had undergone three sequential free flap reconstructions after head and neck cancer was performed. The patients were divided into two groups – older or younger than 65 years old (n = 105 and n = 21, respectively). Patient demographics, intraoperative and postoperative outcomes were noted and analyzed. The overall flap success in this patient cohort was 94.4% (7 flap losses in 126 patients). Cardiovascular complications were significantly more common in the older group (19% vs. 1.9%, p = 0.001). Delirium occurred more frequently in the older group compared with the younger group (23.8% vs. 6.7%, p = 0.023). There were no significant differences regarding surgical complications. With adequate planning, a sequential third free flap can be performed safely and successfully in patients who are more than 65 years of age. Particular attention to the perioperative morbidity in elderly patients is crucial for successful outcomes.

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Section: Discussionsupporting

confidence: 75%

“…In the literature these unfavorable outcomes occur commonly 7 , 8 . However, the need for a third free flap is uncommon, few small to medium size case series have been reported 7 , 9 , 10 . To our knowledge, there is no study that described the impact of aging on operative results after a sequential third free flap to H&N.…”

Section: Introductionmentioning

confidence: 99%

Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Löfstrand

Chang

Lin

et al. 2017

Sci Rep

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“…[ 1 , 2 ] As such, a surge of recurrent tumors which necessitate resection and sequential free flap reconstruction are seen. [ 3 ] As such, choosing the most appropriate flap for subunit based reconstruction in head and neck is crucial, and one can reserve more commonly used flaps for recurrent lesions in the future. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

et al. 2017

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IntroductionOncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use.Materials and methodsFrom December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted.ResultsA 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding.ConclusionThe MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake.

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“…These patients often required further salvage surgery, chemotherapy, and even consideration of reirradiation . Multiple operations among these patients were reported, with higher incidences of flap failure, wound infection, fistula formation, and longer hospital stay . Numerous resections and reirradiation may also affect neuromuscular structures in the upper aerodigestive tract, causing difficulties in breathing, speech, and swallowing, which may place a considerable burden in patients’ quality of life.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with suicidal ideation risk in head and neck cancer: A longitudinal study

Chang

Chen

et al. 2019

The Laryngoscope

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Objectives/Hypothesis: The risk factors associated with suicidal ideation among patients with head and neck cancer (HNC) have rarely been investigated. Thus, this study proposed an effective screening model to facilitate the identification of patients with HNC who are at risk of committing suicide.Study Design: Retrospective longitudinal study. Methods: We recruited 286 inpatients with HNC who were referred to the psychiatry department for an emotional distress assessment during cancer treatment. Sociodemographic and clinical factors, as well as Distress Thermometer (DT) scoring, were gathered and analyzed using multivariate logistic regression.Results: Among the patients, 27 (9.4%) were recognized as having suicidal ideation. A logistic regression analysis revealed five significant indicators associated with suicidal ideation, namely depression (odds ratio [OR]: 42.83), dysphoria (OR: 8.06), hypopharyngeal cancer (OR: 4.61), cancer history (OR: 4.53), and average DT scores (OR: 1.84). Based on the receiver operating characteristic and logistic regression, the model can predict suicidal ideation with 93.4% accuracy (area under the curve value).Conclusions: Our findings provide strong evidence that patients with depression, hypopharyngeal cancer, higher DT scores, and previous cancer history can be quickly screened for suicidal ideation, which may help to prevent suicide events in patients with HNC.

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Feasibility and Outcomes of the Third or More Episodes of Sequential Microvascular Reconstruction for Recurrent or Second Primary Oral Cancer

Cited by 13 publications

References 29 publications

Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

Factors associated with suicidal ideation risk in head and neck cancer: A longitudinal study

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