Sims JR, et al. - The intent of the authors was to illustrate the long-term functional outcomes and related complications of primary surgical management of T4 oropharyngeal cancers reconstructed with radial forearm free flaps. Higher complication rates were carried by the traditional open surgical approaches to large tumors of the oropharynx when compared to the more recent advanced transoral approaches. Yet, they could be used with excellent long-term functional results in certain cases of advanced oropharyngeal cancers not amenable to transoral approaches. A completely oral diet could be achieved in over 90% of patients, with a careful reconstruction of oropharyngeal defects.

Methods

• The scheme of this research was a retrospective review.
• A total of 40 patients with T4 oropharyngeal cancers treated between 2005 and 2015 were analyzed at a tertiary care center.

Results

• Enrollees underwent open surgical resection and radial forearm free flap reconstruction at the time of surgery.
• The necessity of mandibulotomy was noted in 33 (82.5%) cases.
• During this study, 35 (87.5%) patients received adjuvant radiation or combined chemotherapy and radiation.
• Experts conducted tracheostomy in all patients.
• Nevertheless, every patient was eventually decannulated.
• Gastrostomy tube placement was required at some point during treatment by 20 (57.1%) patients.
• Nonetheless, 91.4% candidates were on a completely oral diet with a mean FOSS score of 1.6 by 1 year after completion of treatment.
• The sole factor notably related with poorer FOSS scores was discovered to be the addition of adjuvant treatment.
• It was determined that the overall rates of short and long-term complications were 60.0% and 57.1% respectively.
• Infection (30.0%) and velopharyngeal insufficiency (25.7%) were found to be the most common short and long-term complications.