Which oral cancer patients benefit the most from microsurgical reconstruction?

The objective of this study is to evaluate the impact of microsurgical reconstruction on local recurrence rates and disease-specific survival in patients with oral squamous cell carcinoma. This study is a retrospective review of patients treated at a tertiary cancer center. Six hundred and five patients were included in this study with 529 males (87.44%) and 76 females (12.56%). These were composed of 467 (77.19%) pedicled-flaps reconstructions and 138 (22.81%) free-flap procedures. There was no difference between the groups regarding T stage, N stage, or type of oncological surgery. Use of postoperative radiotherapy was more common in the free-flap group with a significantly shorter time interval than the pedicled-flap group. Free-flap patients had a lower proportion of compromised/close surgical margins (p<0.0001). Univariate analysis disclosed as significant for local recurrence: gender, T stage, microsurgical reconstruction, lymphatic embolization, neural infiltration, and surgical margins. In a multivariate model, T stage (p<0.001), neural infiltration (p <0.001), and microsurgical reconstruction (p<0.001) remained significant. Significant factors for survival in univariate analysis were: gender, T stage, N stage, synchronous neck dissection, microsurgical reconstruction, lymphatic embolization, neural infiltration, and surgical margins. In a multivariate analysis, T stage (p<0.001), N stage (p<0.001), synchronous neck dissection (p=0.025), microsurgical reconstruction (p<0.001), lymphatic embolization (p=0.023), and neural infiltration (p<0.001) remained significant. Regression trees show a significant impact of free flaps in T3/T4 primary tumors. Use of microsurgical flaps provides a significant improvement in local recurrence and survival in patients with T3–T4a primary tumors. It also reduces the interval between surgery and radiotherapy.