K. P. Walsh1, G. Grimberg1, A. J. Scholer1, L. J. Lynch1, J. D. Keith2, R. J. Chokshi1 1New Jersey Medical School,Surgical Oncology, Department Of Surgery,Newark, NJ, USA 2New Jersey Medical School,Department Of Plastic Surgery,Newark, NJ, USA
Introduction: Oncologic resections are often difficult to perform due to the size of defect remaining and exposure of vital structures after resection. At our institution, challenging oncology-related resections are routinely carried out in collaboration, with resection by surgical oncology and reconstruction by plastic surgery. We have previously performed an institutional review demonstrating that radical oncologic resection and subsequent reconstruction of large defects can be safely and effectively performed using this multidisciplinary approach. The aim of the second arm of this study is to identify specific variables in the resection and reconstruction that affect patient outcomes.
Methods: We conducted a retrospective review of 95 adult patients who underwent both an operative resection by a surgical oncologist and subsequent reconstruction by plastic surgery at our institution over a four-year period from 2012 to 2015. Patient demographics were characterized, and an analysis of both the oncologic resection and reconstructive operations was performed. Complications were identified, and the statistical significance of differences in observed outcomes was evaluated using a chi-squared test for categorical data and t-test for continuous data.
Results: Extensive oncology-related resections of the trunk, extremities and head/neck were successfully performed in a group of 95 patients. Major defects (>225 cm2) were encountered in 38.9 % of patients, with a mean size of 240 cm2 (range 3 – 1,125 cm2). A complication was identified in 52.6% of patients, which is similar to the rate of 50% found in the literature for similar operations. As defect size increased, complications were more frequently encountered (p = 0.016). The technique used for reconstruction was also associated with a significant difference in complications (p = 0.017). A complication was observed in 14.3% of adjacent tissue transfers, 40% of skin grafts, 50% of primary/complex closures, 63.6% of free flaps and 64.3% of pedicled flaps. Wound infection (15.8%) and wound dehiscence (9.5%) were the most frequently observed complications. Age, BMI, medical co-morbidity, history of smoking, presence of malignancy, type of insurance, site of surgical resection and tumor pathology were not shown to have a significant impact on the complication rate.
Conclusion: This study illustrates that larger defect size after oncologic resection and subsequent reconstruction has a significant increase in morbidity. While defect size represents the main factor influencing the complication rate in these patients, the type of reconstruction performed has a similar impact, with free flaps and pedicled flaps resulting in more complications than adjacent tissue transfers or skin grafts. Major defects continue to be safely and effectively reconstructed after radical oncologic resections at our institution using a multidisciplinary approach, with complication rates similar to those found in comparable studies.