Tasch Christoph, Pattiss Alexander, Maier Sarah, Lanthaler Monika, Pierer Gerhard
Clinic for Plastic, Reconstructive and Aesthetic Surgery, Innsbruck, Austria.
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
Plast Reconstr Surg Glob Open. 2022 Mar 22;10(3):e4216. doi: 10.1097/GOX.0000000000004216. eCollection 2022 Mar.
The impact of previous radiotherapy on free flap outcome is still a subject of debate. Clinical investigations have come to divergent conclusions and the true effect of radiotherapy (XRT) on flap survival is not definitely known. Most studies investigating the factor often have their methodological limitations such as lack of statistical power as a consequence of the overall low failure rates together with few irradiated cases. This study will attempt to address the question whether previous radiotherapy is associated with a significantly higher incidence of flap failure or not.
A systematic review and meta-analysis were conducted in concordance with the PRISMA protocol using the PubMed database. Fixed-effect and random-effect models were applied to obtain the odds ratio of total flap failure and partial flap failure between radiation and nonradiation groups. Statistical heterogeneity and publication bias were assessed and forest plots and funnel plots were constructed for graphic illustration.
A total of 43 studies were included for qualitative and quantitative analysis involving 18,776 flaps in 17,532 patients. Patients with preoperative XRT were significantly associated with an increased risk for total (odds ratio fixed = 1.675, 95% confidence interval [CI] = 1.405-1.996, < 0.001) and partial free flap failure (odds ratio fixed = 2.161, 95% CI = 1.472-2.172, < 0.001).
The study suggests that preoperative radiotherapy is associated with an increased risk for total and partial free flap failure. Further studies are needed to investigate the effect of total XRT dose and time after radiation on free flap outcome.
既往放疗对游离皮瓣预后的影响仍是一个有争议的话题。临床研究得出了不同的结论，放疗（XRT）对皮瓣存活的真正影响尚不确定。大多数研究该因素的研究往往存在方法学上的局限性，例如由于总体失败率低以及照射病例少而缺乏统计效力。本研究将试图解决既往放疗是否与皮瓣失败发生率显著升高相关的问题。
按照PRISMA方案，使用PubMed数据库进行系统评价和荟萃分析。应用固定效应模型和随机效应模型来获得放疗组和非放疗组之间皮瓣完全失败和部分失败的比值比。评估统计异质性和发表偏倚，并绘制森林图和漏斗图进行直观展示。
共纳入43项研究进行定性和定量分析，涉及17532例患者的18776个皮瓣。术前接受XRT的患者与皮瓣完全失败（固定效应比值比=1.675，95%置信区间[CI]=1.405-1.996，P<0.001）和部分游离皮瓣失败（固定效应比值比=2.161，95%CI=1.472-2.172，P<0.001）的风险增加显著相关。
该研究表明，术前放疗与皮瓣完全失败和部分失败的风险增加相关。需要进一步研究来探讨XRT总剂量和放疗后时间对游离皮瓣预后的影响。
