ICHNO-ECHNO 2022 - Abstract Book

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ICHNO-ECHNO 2022

Purpose or Objective To present our experience and evaluate of functional rehabilitation after surgical treatment of laryngeal and hypopharyngeal tumors using visceral flaps Materials and Methods In the study 121 patients from 25 to 73 years old, with malignant tumors, with the average follow-up period from 1995 to 2019 were included. Pharynx and esophagus reconstruction by using digestive tract free flaps was performed in all patients. Partial microsurgical pharyngoplasty was performed in 107 patients using the following visceral autografts: gastroomental flap (n=48), colic-omental flap (n=28), small intestinal flap (n=22), sigmoid flap (n=1), gastrocolic omentum flap (n=5), ileocolic flap (n=3). In 14 patients with the aim of total reconstruction of the hypopharynx and esophagus, transposition of the gastric pull-up (n=6) , colon flap (n=5), jejunum flap (n=2)and ileocolon flap(n=1). Results In 121 patients in this study the postoperative mortality was 7.4% overall; salivary fistulas occurred in 23%, total flap necrosis occurred in 8.2%; oral nutrition was restored in 90.1%. The voice restoration was performed in 24 patients using a voice prosthesis. In 4 patients, the voice restoration was performed by using autogenous tissue from ileocecal region. The voice restoration occurred in 79.1% with voice prosthetics and in 75% with the use of ileocecal tissue. The five-year survival rates in patients with one-stage reconstruction and delayed reconstruction were 36.4% and 67.3%, respectively. The maximum follow-up period was 20 years. Conclusion The use of visceral flaps in pharyngo-esophageal reconstruction significantly improves patient’s quality of life and contributes to their more complete medical and social rehabilitation. Full-fledged functional restoration in patients with laryngeal cancer makes it possible to use extended surgical approaches in order to improve oncological treatment results. Purpose or Objective The aim was to present and evaluate the clinical experience of treatment for patients with oral cavity malignancies who underwent simultaneous intraoral reconstructions using free or locoregional flaps. Materials and Methods From 2014 to 2021 at Sechenov University, a total of 118 patients underwent intraoral reconstruction after radical surgery for oral cancer. 61.9% were males, and 38.1% were females. The average age was 55 years (range 26-82 years). Group 1 - 61 patients received immediate reconstruction with locoregional flaps.Axial musculocutaneous flaps were used, including the pectoralis major flap (63.9%), infrahyoid flap (19.7%), sternocleidomastoid flap (9.8%), and thoracodorsal artery flap (6.6%). Group 2 - 57 patients received microsurgical reconstruction with free flaps, of which 61.4% were innervated and 38.6% were non-innervated. Choice of flaps included radial forearm free flaps (59.6%), thoracodorsal artery flaps (24.6%), anterolateral thigh flaps (8.8%), and rectus abdominis free flaps (4.7%). Parameters of comparison included: sex, age, social status, etiology, stage of the disease, neoadjuvant therapy, tumor location, dependence on a tracheostomy, postoperative complications and duration of hospital stay. Results In group 1, males predominated (70.5%), while in group 2, the sex ratio was approximately equal (52.6% to 47.4%). The average age in group 1 was 58 years old (range 26-82) and group 2 – 53 years old (range 26-72). Employees were 39.3% and 40% respectively. In group 1, 95.1% of patients had squamous cell carcinoma and 3.3% adenocarcinoma, in comparison to group 2 - 86.0% and 10.5% respectively. N+ was detected in 34. 4% in the first group, and in 22,8% in the second group. In group 1, 65.5% of patients received neoadjuvant chemotherapy and in group 2 – 50,9%. 38.6% of patients in group 1 received preoperative radiation therapy, and in 45.8% in group 2. Locoregional flaps were used in patients with tongue (33%), floor of the mouth (28%), buccal mucosa (4.9%), retromalar triangle (6.6%), and palate (3.3%) defects. Free flaps were used in patients with tongue (45.7%), floor of the mouth (7.2%), buccal mucosa (5.3%), retromalar triangle (1.8%), and palate (21.0%) defects. Tracheostomy in group 1 was performed more often (81.7%) in comparison to group 2 (68.4%). Postoperative complications in group 1 were 9.8%, lower than in group 2 – 19.3%. In group 1, the overall flap survival rate was 100%, and in group 2 - 96.5%. Average hospital stay in the first group was 26.97 days (range 7-85), slightly different in the second - 24.72 days (range 5-48). Conclusion When choosing a free flap, it is necessary to consider the N+ status, age and presence of comorbidities. Microsurgery is the method of choice for tongue reconstruction. Free flaps are the method of choice for achieving good functional outcomes. However, in cases where microsurgery is impossible to perform for several reasons, the usage of locoregional flaps is an effective alternative method for treatment. PO-0112 Flap selection for the reconstruction of intraoral oncologic defects: locoregional or free flaps? I. Reshetov 1 , A. Zakirova 1 , F. Kurdi 1 1 Sechevov University, Department of Oncology, Radiotherapy and Plastic Surgery, Moscow, Russian Federation