Pfister Pablo, Speck Nicole E, Gahl Brigitta, Muller Laurent, Fürst Thomas, Kappos Elisabeth A, Schaefer Dirk J, Largo Rene D, Ismail Tarek
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
Surgical Outcome Research Center Basel, University Hospital Basel, Basel, Switzerland.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:24-34. doi: 10.1016/j.bjps.2024.02.026. Epub 2024 Feb 7.
Limited data exist regarding the effect of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction. However, an adequate free flap volume is an important predictor of functional and patient-reported outcomes in head and neck reconstruction.
A systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 6710 abstracts were screened, and 36 full-text papers were reviewed. Nineteen studies met the inclusion criteria and were used to extract data for this analysis.
A meta-analysis of 14 two-arm studies comparing the impact of adjuvant radiotherapy versus no adjuvant radiotherapy was performed. The main analysis revealed that 6 months postoperatively, irradiated flaps showed a significant reduction of volume (average, 9.4%) compared to nonirradiated flaps. The average interpolated pooled flap volumes 6 months postoperatively were 76.4% in irradiated flaps and 81.8% in nonirradiated flaps. After a median postoperative follow-up of 12 months, the total flap volume was 62.6% for irradiated flaps and 76% for nonirradiated flaps. Four studies reported that chemotherapy had no significant impact on free flap volume.
Compared to nonirradiated flaps, irradiated flaps were significantly reduced in volume (range, 5% to 15.5%). Clinicians should take this into account when planning the surgical reconstruction of head and neck defects. Conducting large-scale prospective studies with standardized protocols and well-defined follow-up measurements could contribute to defining the ideal, personalized free flap volume for optimal function and patient-reported outcomes.
关于辅助放化疗对头颈部重建中游离皮瓣体积的影响，现有数据有限。然而，足够的游离皮瓣体积是头颈部重建中功能及患者报告结局的重要预测指标。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）和Cochrane对照试验中央注册库进行系统评价。共筛选6710篇摘要，审阅36篇全文论文。19项研究符合纳入标准并用于提取本分析的数据。
对14项比较辅助放疗与不放疗影响的双臂研究进行Meta分析。主要分析显示，术后6个月，接受放疗的皮瓣体积与未放疗的皮瓣相比显著减小（平均9.4%）。术后6个月，接受放疗皮瓣的平均内插合并皮瓣体积为76.4%，未放疗皮瓣为81.8%。术后中位随访12个月后，接受放疗皮瓣的总皮瓣体积为62.6%，未放疗皮瓣为76%。四项研究报告化疗对游离皮瓣体积无显著影响。
与未放疗的皮瓣相比，接受放疗的皮瓣体积显著减小（范围为5%至15.5%）。临床医生在对头颈部缺损进行手术重建规划时应考虑到这一点。开展采用标准化方案和明确随访测量的大规模前瞻性研究，可能有助于确定理想的个性化游离皮瓣体积，以实现最佳功能和患者报告结局。
