RESUMO
Objetivo: eportar nuestra experiencia en la reconstrucción de pacientes con tumores de cabeza y cuello. Materiales y Métodos: Revisión retrospectiva de fichas clínicas de los pacientes sometidos a reconstrucciones con colgajos microquirúrgicos entre los años 2007 y 2020 en la Fundación Arturo López Pérez. Resultados: En este período 186 cirugías fueron realizadas, lo que correspondió a 173 pacientes, la mediana de edad fue de 59 años, 55% eran hombres. 29% correspondieron a rescates quirúrgicos. Al diagnóstico 110 (54%) tenían una enfermedad localmente avanzada (T3-T4). El sitio anatómico más frecuentemente reconstruido fue la cavidad oral, 83(45%). La histología más frecuente fue el carcinoma escamoso. Los colgajos más utilizados fueron el osteocutáneo de peroné, anterolateral de muslo (ALT) y antebraquial. La sobrevida global a 5 años fue 44,3%, con amplia variabilidad entre las distintas histologías. Discusión: En el análisis de nuestros resultados en dos períodos de siete años (2007-2013 y 2014-2020), el porcentaje de falla de colgajo disminuyó (10% versus 2,6%; p = 0,012); al igual que la estadía hospitalaria que disminuyó (de una mediana de 23 días a 18 días; p = 0,041). El uso del colgajo ALT aumentó de 14% a 29%, esto último aprovechando la versatilidad del colgajo de ALT para la fabricación de múltiples paletas cutáneas, que permiten reconstrucciones más complejas. Conclusión: Las reconstrucciones microquirúrgicas en nuestra institución son una opción estandarizada, confiable y comparable con centros internacionales.
Objective: To report our experience, and success rate for head and neck reconstruction in a Chilean oncologic center. Methods: Charts were reviewed retrospectively for all patients treated surgically for head and neck tumors that needed a free flap reconstruction from 2007 to 2020. The demographics and epidemiologic variables were described. Overall survival was calculated with the Kaplan-Meier method. Results: One hundred and eighty-six operations were performed on 173 patients; the median age was 59 years, and 55% were male. Twenty-nine percent of patients required a surgical rescue. The most frequently used free flaps were the anterolateral thigh, fibula osteocutaneous, and radial forearm. A second free flap was needed in 13 patients. Five-year overall survival for the whole cohort was 44.3% and varied according to histology: 28.2% for squamous cell carcinoma and 68.9% for salivary gland histology. Discussion: In analysis of our results in two seven-year periods (2007-2013 and 2014-2020), the percentage of flaps that failed decreased (10% earlier versus 2.6% later; p =.012); the length of hospital stay declined (median 23 days earlier vs 18 days later; p =.041), and the use of anterolateral thigh flaps increased 14% vs 29%, taking advantage of the versatility of the anterolateral thigh flap for the fabrication of multiple skin palettes, allowing for more complex reconstructions. Conclusion: In our institution, outcomes with free flap reconstruction for head and neck were satisfactory and improved with operator experience.
RESUMO
OBJECTIVES: Head and neck mucosal melanoma (HNMM) is a rare disease with a poor prognosis. The aim of this research was to analyze clinical characteristics and prognostic factors in a Latin American cohort. STUDY DESIGN: A retrospective chart review of patients with HNMM treated between 2008 and 2019 was conducted. Demographic characteristics, tumor characteristics, surgical treatment, adjuvant therapy, and oncologic outcomes were recorded. RESULTS: Twenty HNMMs were identified; 60% were in men. The most frequent primary location was the nasal cavity (10; 50%). Regional disease was uncommon and limited to the oral cavity. The median overall survival was 29 months; the 3- and 5-year overall survival rates were 37.2% and 26.6%, respectively. Univariate analysis revealed that predictors of a worse overall survival were paranasal location (hazard ratio [HR], 4.61; 95% confidence interval [CI], 1.61-18.40; P = .030), positive lymph nodes (HR, 6.00; 95% CI, 1.30-27.7; P = .022), positive margins (HR, 4.32; 95% CI, 1.08-17.2; P = .039), bone invasion (HR, 3.27;95% CI, 1.05-10.1; P = .041), and lymphovascular invasion (HR, 3.82; CI, 1.03-14.2; P = .045). Three-year recurrence-free survival was 17.3%, and most of the recurrences were with distant disease. CONCLUSIONS: HNMM is an infrequent disease with an aggressive behavior. Survival outcomes are related to location of the primary disease, regional spread, lymphovascular invasion, and bone invasion.