Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer

Seungtaek Choi, David Schwartz, D. Greg Farwell, Mary Austin-Seymour, Neal Futran

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Objective: To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction. Design: Retrospective cohort study. Setting: University of Washington Medical Center, Seattle, a tertiary care hospital. Patients: A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months). Main Outcome Measures: Rate and severity of local postoperative complications. Results: Fifty-four patients (54%) had at least 1 post-operative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P =.26, Χ2 analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use. Conclusions: Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.

Original languageEnglish (US)
Pages (from-to)1308-1312
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume130
Issue number11
DOIs
StatePublished - Nov 1 2004

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Free Tissue Flaps
Head and Neck Neoplasms
Radiotherapy
Radiation
Cohort Studies
Tobacco Use
Tertiary Healthcare
Mandible
Tertiary Care Centers
Comorbidity
Neck
Referral and Consultation
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. / Choi, Seungtaek; Schwartz, David; Farwell, D. Greg; Austin-Seymour, Mary; Futran, Neal.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 130, No. 11, 01.11.2004, p. 1308-1312.

Research output: Contribution to journalArticle

Choi, Seungtaek ; Schwartz, David ; Farwell, D. Greg ; Austin-Seymour, Mary ; Futran, Neal. / Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. In: Archives of Otolaryngology - Head and Neck Surgery. 2004 ; Vol. 130, No. 11. pp. 1308-1312.
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abstract = "Objective: To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction. Design: Retrospective cohort study. Setting: University of Washington Medical Center, Seattle, a tertiary care hospital. Patients: A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months). Main Outcome Measures: Rate and severity of local postoperative complications. Results: Fifty-four patients (54{\%}) had at least 1 post-operative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54{\%}] of 28 patients in the no XRT group, 24 [65{\%}] of 37 patients in the preoperative XRT group, and 16 [46{\%}] of 35 patients in the postoperative XRT group; P =.26, Χ2 analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use. Conclusions: Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.",
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N2 - Objective: To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction. Design: Retrospective cohort study. Setting: University of Washington Medical Center, Seattle, a tertiary care hospital. Patients: A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months). Main Outcome Measures: Rate and severity of local postoperative complications. Results: Fifty-four patients (54%) had at least 1 post-operative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P =.26, Χ2 analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use. Conclusions: Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.

AB - Objective: To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction. Design: Retrospective cohort study. Setting: University of Washington Medical Center, Seattle, a tertiary care hospital. Patients: A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months). Main Outcome Measures: Rate and severity of local postoperative complications. Results: Fifty-four patients (54%) had at least 1 post-operative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P =.26, Χ2 analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use. Conclusions: Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.

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