Volume 167, Issue 4 p. 645-649
Facial Plastic and Reconstructive Surgery

Occult Metastases During Salvage Oral Cavity and Oropharyngeal Free Flaps: Oncologic Outcomes

Margaret E. Wieser

Corresponding Author

Margaret E. Wieser

Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA

Corresponding Author: Margaret E. Wieser, School of Medicine, University of Missouri, One Hospital Dr, Columbia, MO 65212, USA. Email: [email protected]Search for more papers by this author
Emily S. Sagalow

Emily S. Sagalow

Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA

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Alyssa Givens

Alyssa Givens

Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA

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Joseph M. Curry MD

Joseph M. Curry MD

Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA

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Laura M. Dooley MD

Laura M. Dooley MD

Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA

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Tabitha L. Galloway MD

Tabitha L. Galloway MD

Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA

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Robert P. Zitsch MD

Robert P. Zitsch MD

Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA

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Patrick T. Tassone MD

Patrick T. Tassone MD

Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA

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First published: 05 April 2022

This article was presented at the 2021 AAO-HNSF Annual Meeting & OTO Experience; October 3-6, 2021; Los Angeles, California.

Abstract

Objectives

To define rates of occult metastases in salvage oral cavity and oropharyngeal cancer resection requiring free flap, to examine the location of occult metastases, and to determine associations between occult metastasis and survival.

Study Design

Retrospective cohort study.

Setting

Two tertiary care referral centers.

Methods

We identified previous cases of irradiation with recurrent or second primary oral cavity or oropharyngeal squamous cell carcinoma that had no evidence of regional metastasis and required free tissue transfer reconstruction of the primary site. Patients who underwent elective neck dissection or exploration were reviewed. The main outcome measures were the presence and location of occult nodal metastasis. Disease-free survival and overall survival were measured. Odds ratios and hazard ratios were used for analysis.

Results

A total of 83 patients were included: 52 with oral cavity primary tumors and 31 with oropharynx. An overall 78 (94%) underwent elective salvage neck dissection. Occult metastases were found in 9 (11.5%) patients. The most common nodal station for occult metastasis was level 2. Neither elective neck dissection nor the presence of occult metastasis was significantly associated with regional disease-free or overall survival. Oropharyngeal primary tumors were associated with higher risk of occult metastasis (odds ratio, 1.38; P <. 01) and worse overall survival (hazard ratio, 2.09; P =. 01).

Conclusion

There is a low incidence of occult metastasis in postradiated recurrent or second primary oral cavity and oropharyngeal tumors. Elective neck dissection and occult nodal metastases were not associated with regional or overall survival. This series may help surgeons make decisions regarding the extent of neck surgery after prior radiation, especially when free flap reconstruction is required.