Comparison of Functional and Survival Outcomes in Pedicled and Microsurgical Flap Reconstruction for Near-Total and Total Glossectomies

Abstract

Introduction: Patients with advanced carcinoma tongue end up with near-total/total glossectomy (NTG/TG). We intended to compare functional, oncological, and survival outcomes of patients undergoing pedicled and microsurgical flap reconstruction in NTG/TG patients at our hospital. Methodology: A prospective study was conducted for 7 years on 91 patients with carcinoma tongue who underwent NTG/TG at our institute. Patients underwent anterolateral thigh (ALT), free radial artery forearm flap (FRAFF), and pectoralis major myocutaneous (PMMC) flap reconstruction and were followed up for immediate complications and functional outcomes for speech, swallowing, and decannulation after completion of adjuvant treatment and then for survival rates for a period of 60 months and statistically analysed with log rank test and Fisher’s exact test for correlation. Results: Ninety-one (42.85%) patients underwent NTG, while 57.14% underwent TG. 85% of patients had >5 mm margin, 14% had ≤ of 5 mm, and none were positive. 57% of patients did not have postoperative complications and 10% underwent re-exploration. During follow-up, 85.7% of patients were able to take orally: 52% soft diet and 32% liquid diet. Multivariate analysis of individual flaps, swallowing, and speech intelligibility values were significant. After 5 years of postadjuvant therapy, there was 76% overall survival, 11% local recurrence and 12% had regional recurrence. Discussion: Morbidity and functional outcome depends on the extent of resection. PMMC flaps can be done on lack of expertise. FRAFF has better functional outcomes owing to pliability of flap. ALT and other bulky flaps require expertise and are prone to flap-related complications. Planning of reconstruction should be based on the defect size together with counseling of patients regarding the risk of complications and delay in adjuvant therapy.

Quality of life and swallowing outcomes following major glossectomy: A prospective single‐center experience

“…Though we have compared our results with other published series (Table S3), the lack of a comparator arm is definitely a noteworthy limitation. Despite previously published studies not demonstrating a major difference between PMMF and free flap reconstruction, this study is unable to provide an explanation for the delayed decannulation time in our cohort in the absence of a comparator cohort reconstructed with free flaps 16 . Also VFSS was done only in selected cases.…”

“…The same group in their subsequent publication compared the results of PMMF reconstruction with radial artery forearm flap and anterolateral thigh flap. 16 Counterintuitively, the swallowing outcomes and the rate of complication were found to favor the PMMF reconstruction group. The above study had a comparator arm which our study lacked but again structured reporting of QoL and swallowing was deficient.…”

“…Though this study showed remarkable short‐term outcomes in a large number of NTG cases reconstructed with PMMF, it lacked structured assessment using validated swallowing scores and QoL scores. The same group in their subsequent publication compared the results of PMMF reconstruction with radial artery forearm flap and anterolateral thigh flap 16 . Counterintuitively, the swallowing outcomes and the rate of complication were found to favor the PMMF reconstruction group.…”

“…13 We have compared the results of our study with those quoted in the literature (Table S3). 5,[12][13][14][15][16][17][18] Manrique et al performed a systematic review and meta-analysis on the speech and swallowing outcomes following a major glossectomy. 6 Their study also included published literature on total glossectomy with laryngeal preservation.…”

“…Despite previously published studies not demonstrating a major difference between PMMF and free flap reconstruction, this study is unable to provide an explanation for the delayed decannulation time in our cohort in the absence of a comparator cohort reconstructed with free flaps. 16 Also VFSS was done only in selected cases. Considering impairment of bolus propulsion at the level of tongue base in our subset of patients, the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES), which takes into account the amount of residue based on the type of bolus, would have been useful.…”