Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy.
BACKGROUND: The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to ide...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3983152?pdf=render |
| _version_ | 1819231789851344896 |
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| author | Chih-Hung Lin Chung-Jan Kang Chung-Kan Tsao Christopher Glenn Wallace Li-Yu Lee Chien-Yu Lin Hung-Ming Wang Shu-Hang Ng Tzu-Chen Yen Chun-Ta Liao |
| author_facet | Chih-Hung Lin Chung-Jan Kang Chung-Kan Tsao Christopher Glenn Wallace Li-Yu Lee Chien-Yu Lin Hung-Ming Wang Shu-Hang Ng Tzu-Chen Yen Chun-Ta Liao |
| author_sort | Chih-Hung Lin |
| collection | DOAJ |
| description | BACKGROUND: The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions. METHODS: Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy. RESULTS: Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs. CONCLUSIONS: Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions. |
| first_indexed | 2024-12-23T11:50:33Z |
| format | Article |
| id | doaj.art-9ae0ddbca66c4f03b605bb3f25448c66 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-23T11:50:33Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-9ae0ddbca66c4f03b605bb3f25448c662022-12-21T17:48:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0194e9431510.1371/journal.pone.0094315Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy.Chih-Hung LinChung-Jan KangChung-Kan TsaoChristopher Glenn WallaceLi-Yu LeeChien-Yu LinHung-Ming WangShu-Hang NgTzu-Chen YenChun-Ta LiaoBACKGROUND: The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions. METHODS: Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy. RESULTS: Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs. CONCLUSIONS: Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.http://europepmc.org/articles/PMC3983152?pdf=render |
| spellingShingle | Chih-Hung Lin Chung-Jan Kang Chung-Kan Tsao Christopher Glenn Wallace Li-Yu Lee Chien-Yu Lin Hung-Ming Wang Shu-Hang Ng Tzu-Chen Yen Chun-Ta Liao Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. PLoS ONE |
| title | Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. |
| title_full | Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. |
| title_fullStr | Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. |
| title_full_unstemmed | Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. |
| title_short | Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. |
| title_sort | priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy |
| url | http://europepmc.org/articles/PMC3983152?pdf=render |
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