de Vicente Juan Carlos, Rodríguez-Santamarta Tania, Rosado Pablo, Peña Ignacio, de Villalaín Lucas
Servicio de Cirugía Maxilofacial, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, and Facultad de Medicina, Julián Clavería, Oviedo, Asturias, Spain.
J Oral Maxillofac Surg. 2012 Feb;70(2):453-9. doi: 10.1016/j.joms.2011.02.020.
The purpose of the present study was to assess the effect of free-flap reconstruction on the survival of patients treated for oral squamous cell carcinoma.
The present study was based on a retrospective cohort of 98 patients. Of the 98 patients, 49 underwent surgical reconstruction with microvascular tissue transfer (test group) and in 49 (control group), only local or regional flaps were used.
For the free-flap group, the average follow-up period was 34.6 months. For the control group, the average follow-up was 39.8 months. At the end of the follow-up period, 23 (47%) and 33 (67.3%) patients had died of oral squamous cell carcinoma in the microvascular reconstructive and control group, respectively. The difference in the final status between the 2 groups was statistically significant (P = .03). In the free-flap group, the mean and median survival time was 65 and 60 months. In the locoregional flap group, the mean and median survival time was 54 and 24 months, respectively. No difference was seen in the survival time between the free-flap and local flap groups (P = .2). Univariate Kaplan-Meier analysis revealed that positive surgical margins were significantly associated with shortened survival in the free-flap group and that recurrence was significant in both reconstructive groups. On multivariate Cox regression analysis, the status of the resection margin (P = .07) and tumor recurrence (P < .0005) showed a significant relationship with survival.
Patients with free-flap reconstruction of surgically created defects after oral cancer resection showed a trend toward better 5-year survival.
本研究旨在评估游离皮瓣重建对口腔鳞状细胞癌患者生存情况的影响。
本研究基于一项对98例患者的回顾性队列研究。在这98例患者中，49例接受了微血管组织转移的手术重建（试验组），另外49例（对照组）仅使用了局部或区域皮瓣。
游离皮瓣组的平均随访期为34.6个月。对照组的平均随访期为39.8个月。随访期末，微血管重建组和对照组分别有23例（47%）和33例（67.3%）患者死于口腔鳞状细胞癌。两组最终状态的差异具有统计学意义（P = 0.03）。在游离皮瓣组，平均生存时间和中位生存时间分别为65个月和60个月。在局部区域皮瓣组，平均生存时间和中位生存时间分别为54个月和24个月。游离皮瓣组和局部皮瓣组的生存时间未见差异（P = 0.2）。单因素Kaplan-Meier分析显示，手术切缘阳性与游离皮瓣组生存时间缩短显著相关，且在两个重建组中复发均显著。多因素Cox回归分析显示，切缘状态（P = 0.07）和肿瘤复发（P < 0.0005）与生存显著相关。
口腔癌切除术后采用游离皮瓣重建手术造成缺损的患者，5年生存率有提高的趋势。
