Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Br J Oral Maxillofac Surg. 2021 Apr;59(3):e79-e98. doi: 10.1016/j.bjoms.2020.07.020. Epub 2020 Jul 26.
Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75-33.49; p<0.01), and of 4.57% for overall surgical complications (95% CI: 1.97-7.15; p<0.01). No significant difference in risk was found for flap failure (95% CI: -4.33-9.90; p=0.44), surgical site infection (95% CI: -0.88-2.60; p=0.33) and fistula formation (95% CI: -3.81-3.71; p=0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I=63.02%; p=0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.
游离血管化组织瓣重建术适用于头颈部大缺损，这些缺损主要是由于头颈部癌症引起的。吸烟是头颈部癌症的一个主要危险因素，许多接受头颈部重建手术的患者都有吸烟史。本荟萃分析的目的是确定吸烟对头颈部游离血管化组织瓣重建术后手术并发症的影响。采用系统评价方法，检索了报告并比较吸烟者和非吸烟者游离血管化组织瓣重建术后总体手术并发症发生率的文章，并根据 PRISMA 指南筛选合格文章。使用纽卡斯尔-渥太华质量评估量表进行偏倚风险分析。使用 OpenMetaAnalyst（开源）软件对总体手术并发症、皮瓣失败、手术部位感染、瘘管和血肿的发生率进行定量比较，以比较吸烟者和非吸烟者之间的发生率。对于伤口裂开、出血、神经损伤和伤口愈合受损，仅进行定性分析。对 46 篇文章进行了筛选；对 30 篇全文进行了审查，19 项研究纳入了定量荟萃分析。19 项研究中，18 项为回顾性研究，1 项为前瞻性研究。共有 2155 名吸烟者和 3124 名非吸烟者纳入荟萃分析。吸烟与血肿风险增加 19.12%显著相关（95%置信区间：4.75-33.49；p<0.01），与总体手术并发症风险增加 4.57%显著相关（95%置信区间：1.97-7.15；p<0.01）。皮瓣失败（95%置信区间：-4.33-9.90；p=0.44）、手术部位感染（95%置信区间：-0.88-2.60；p=0.33）和瘘管形成（95%置信区间：-3.81-3.71；p=0.98）之间的风险差异无统计学意义。仅在皮瓣失败方面发现显著异质性（I=63.02%；p=0.03）。吸烟与总体手术并发症和血肿风险增加显著相关，但似乎不会影响其他术后并发症。鼓励需要头颈部重建手术的患者戒烟仍然很重要，但无需为了预防研究中的并发症而延迟手术以建立非吸烟间隔。需要更多高质量的回顾性或前瞻性研究，并制定标准化方案，以得出明确的结论。
