Quimby Alexandra E, Khalil Diana, Johnson-Obaseki Stephanie
Department of Otolaryngology-Head and Neck Surgery, University of Ottawa.
Ottawa Hospital, Ottawa, Ontario, Canada.
Laryngoscope. 2018 Nov;128(11):2566-2572. doi: 10.1002/lary.27250. Epub 2018 Jun 22.
Controversy exists regarding the surgical management of cutaneous melanoma and the optimal timing of reconstruction. One approach to ensuring an oncologically sound outcome is a two-stage procedure, with reconstruction delayed for negative permanent section margins. Alternatively, a single-stage excision with immediate reconstruction is advantageous because it limits both resource use and patient morbidity from multiple procedures. We sought to examine available published data on the oncologic outcomes associated with immediate versus delayed reconstruction of cutaneous melanoma in the head and neck region.
We performed a systematic review using EMBASE, Ovid MEDLINE, and PubMed. We examined all English-language studies reporting oncologic outcomes (positive margins and/or local recurrence rates) of single-stage or delayed reconstruction of cutaneous melanoma in the head and neck region. Our primary outcomes of interest were rates of positive margins requiring re-excision and rates of local recurrence. A total of 1,557 studies were screened by three independent reviewers.
Nine studies met inclusion criteria for final analysis. Two of the nine studies directly compared immediate versus delayed reconstruction and demonstrated lower rates of positive margins in the immediate reconstruction group (odds ratio 3.7, [95% CI 0. 79-17. 34]).
There are a paucity of studies directly comparing oncologic outcomes associated with immediate versus delayed reconstruction following excision of head and neck cutaneous melanoma. Based on a limited amount of heterogeneous data, single-stage excision with immediate reconstruction may be an oncologically sound alternative to delayed reconstruction for head and neck cutaneous melanoma.
3a. Laryngoscope, 2566-2572, 2018.
皮肤黑色素瘤的手术治疗及重建的最佳时机存在争议。确保肿瘤学上良好结果的一种方法是两阶段手术，即延迟重建直至永久切片切缘为阴性。另一种方法是一期切除并立即重建，其优点是限制了资源使用和多次手术给患者带来的发病率。我们试图研究已发表的关于头颈部皮肤黑色素瘤立即重建与延迟重建相关肿瘤学结果的可用数据。
我们使用EMBASE、Ovid MEDLINE和PubMed进行了系统评价。我们检索了所有报告头颈部皮肤黑色素瘤一期或延迟重建的肿瘤学结果（阳性切缘和/或局部复发率）的英文研究。我们感兴趣的主要结果是需要再次切除的阳性切缘率和局部复发率。由三位独立的评审员共筛选了1557项研究。
九项研究符合最终分析的纳入标准。九项研究中的两项直接比较了立即重建与延迟重建，结果显示立即重建组的阳性切缘率较低（优势比3.7，[95%可信区间0.79 - 17.34]）。
直接比较头颈部皮肤黑色素瘤切除后立即重建与延迟重建相关肿瘤学结果的研究较少。基于有限的异质性数据，一期切除并立即重建对于头颈部皮肤黑色素瘤可能是一种在肿瘤学上合理的替代延迟重建的方法。
3a。《喉镜》，2566 - 2572，2018年。
