K. P. Walsh1, G. Grimberg1, A. J. Scholer1, L. J. Lynch1, J. D. Keith2, R. J. Chokshi1 1New Jersey Medical School,Division Of Surgical Oncology, Department Of Surgery,Newark, NJ, USA 2New Jersey Medical School,Department Of Plastic Surgery,Newark, NJ, USA
Introduction: Oncologic resections vary in size and technical difficulty due to a multitude of factors: oncologic process, margin needed, surrounding structures involved and subsequent defect size. After an extensive resection, many surgeons are challenged by the reconstruction due to both the size of the defect and the vital structures that are exposed. The purpose of this study was to review our institution’s experience with oncology-related resection and subsequent reconstruction in patients with extensive defects. To date, this is the largest series examining oncology-related resection and subsequent reconstruction in adults.
Methods: We conducted a retrospective review of 95 adult patients who underwent both an operative resection by a surgical oncologist and a 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 subsequent reconstructive operations was performed.
Results: The cohort consisted of 95 patients with a mean age of 52.7 (26-87) years old and mean BMI of 27.8 (16-46). The majority of our patients were smokers (51.6 %) and had significant medical comorbidities (56.8 %). Of the resections, 66% were for malignancy. The most common malignancies were: adenocarcinoma of the GI tract (22.2 %), sarcoma (15.9 %), squamous cell carcinoma (15.9 %) and basal cell carcinoma (12.7 %). The sites of resection included the trunk (44.2 %), extremities (31.6 %) and head & neck (24.2 %). Major defects (>225 cm2) were encountered in 38.9 % of patients, with a mean defect size of 240 cm2. Many reconstructive techniques were employed, including primary/complex closure (10.1 %), skin graft (10.1 %), adjacent tissue transfer (14.7 %), pedicled flaps (29.5 %) and free flaps (34.7 %). The most frequently used free flap was an anterolateral thigh flap (60.1%), and common pedicled flaps included rectus abdominis (34.2 %), gracilis (13.2 %) and gastrocnemius flaps (10.5 %).
Conclusion: Radical oncologic resection and subsequent reconstruction of large defects can be safely and effectively performed using a multi-disciplinary approach. Collaborative efforts between surgical oncology and plastic surgery have enabled patients with significant medical comorbidities to undergo a variety of successful oncologic resections with subsequent effective reconstruction of major defects.