The impacts of intra-arterial chemotherapy on head and neck microvascular reconstruction
Journal
Journal of the Formosan Medical Association
Date Issued
2020
Author(s)
Chung M.-J.
Tseng T.-Y.
Abstract
Background: For locally advanced head and neck cancers, intra-arterial (IA) chemotherapy is utilized for locoregional control with favorable results. The study aimed to evaluate the surgical outcomes of microsurgical reconstruction in head and neck cancer patients with IA chemotherapy Methods: This cohort study retrospectively reviewed patients who underwent head and neck microsurgical reconstruction from January 2014 to August 2018. Patients with prior history of chemotherapy were included and categorized into two groups according to history of IA chemotherapy (IA group)/intravenous chemotherapy (IV group). Flap survival was evaluated along with microsurgical revision rates and complications. Recipient vessel specimens were analyzed by histological examination. A 1:1 propensity score matched analysis was performed. Results: The study cohort included 45 patients with IA chemotherapy and 201 patients with IV chemotherapy. After propensity score matching, the difference in total flap loss and microsurgical revision rates were nonsignificant between two groups. However, the IA group had significantly higher rates of arterial thrombosis (Odds ratio [OR] 4.98; 95%CI, 1.28–19.38; p = 0.021), wound-related complications (OR 3.30; 95%CI, 1.21–9.02; p = 0.02) and revision surgery within one month (OR 3.73; 95%CI, 1.10–12.64; p = 0.035). Based on histology, IA group vessels showed a higher intima/media ratio than the IV group (0.45 ± 0.06 versus 0.23 ± 0.03, p = 0.02) Conclusion: Despite treating local advanced head and neck cancers with good results, IA chemotherapy may cause subsequent deleterious effects on local tissue due to the high concentration of cytotoxic chemotherapeutic agents. Surgeons should be cautious in selection of recipient vessels when performing microvascular reconstruction. ? 2019
SDGs
Other Subjects
bevacizumab; cisplatin; mitomycin; adult; arterial wall thickness; artery thrombosis; Article; cancer chemotherapy; cancer patient; clinical evaluation; clinical outcome; cohort analysis; demography; female; graft failure; head and neck cancer; head and neck surgery; histology; human; major clinical study; male; microvascular surgery; middle aged; postoperative complication; propensity score; retrospective study; skin flap survival; surgical wound; head and neck tumor; microsurgery; neck; surgical flaps; Head and Neck Neoplasms; Humans; Microsurgery; Neck; Postoperative Complications; Retrospective Studies; Surgical Flaps
Publisher
Elsevier B.V.
Type
journal article