Background- Neoadjuvant chemotherapy(NACT) has been found to significantly improve overall survival in borderline resectable cancers. There has been a concern regarding the influence of chemotherapeutic agents on wound healing. This study compares the early postoperative complications in patients who underwent free flap reconstruction after NACT with patients who did not receive NACT.
Methods- Retrospective analysis of patients with locally advanced oral cavity cancers, who received NACT. Early postoperative complications like re-explorations, flap failures, neck infection, wound dehiscences, oro-cutaneous fistulas and post-operative day of discharge were noted and compared with patients who underwent free flap without receiving NACT.
Results- Out of 1429 patients who underwent free flap, 62 patients had received neoadjuvant chemotherapy.
The mean postoperative day of discharge was 11.5 in NACT and 10.5 in non NACT group.
33 out of the 62 (53.23%) patients developed neck collection which was significantly higher than the non-NACT group. 29 patients (46.77%) had a wound dehiscence which was significantly higher than the non-NACT group.. A total of 8 patients needed a re-exploration of which 5 were salvaged and 3 were lost out of a total of 62 (4.84%). The re-exploration rates and flap survival rates were comparable.
Conclusions- Although wound complications increase with the use of NACT, it does not lead to an increase in flap failures, an increase in hospital stay or a delay in adjuvant treatment. Microvascular free flap reconstruction can safely be performed in patients of locally advanced oral cavity cancers post-NACT