Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Flap reconstruction for oncologic defects of the oral cavity is often indicated for large malignancies, such as T3/4 cancers, while reconstruction is often not indicated for small T1 defects. For malignancies in the intermediate T2 category, the indication is less clear. Margin control is of utmost importance when managing oral cavity malignancies. The aim of the present study is to examine how T2 oral cavity defects are reconstructed, if at all, and wether performing flap reconstruction leads to better margin control.
Methods: A multi-center cohort study was carried out over a 5-year period. Patients met inclusion criteria if pathology revealed a T2 squamous cell carcinoma. Data collected included pathological factors, including size, depth, margin status and distance to margin, and flap characteristics including type of flap and size.
Results: A total of 169 patients met inclusion criteria and were available for analysis. The mean age of the cohort was 66.1 years. The most common oral cavity subsite was the oral tongue (n=91, 54%). Flap reconstruction was utilized in 80 (47%) cases, with radial forearm being the most commonly used. Patients who received a flap for reconstruction were, on average, 5 years younger (p=0.005), and were more likely to have defects of the retromolar trigone and mandible, and less likely of the oral tongue (p=0.001). Margins were clear in 94% of patients, with an average distance to margin of 3.5mm, and was not statistically significantly different between flap or no flap reconstruction (p=0.342). Carcinoma in situ at the margin was twice as likely if no flap was utilized, but did not reach significance (p=0.053), and margins were more likely to be closest at the deep margin if no flap was used.
Discussion: Reconstruction of T2 oral cavity defects is variable, with an equal proportion of patients receiving a flap and no flap. Margin status was not significantly different between the groups, but carcinoma in situ at the margin was more likely if no flap was used.