Survival and functional outcomes of patients who underwent facial-submental artery island flap reconstruction after oral cavity or HPV-negative oropharyngeal squamous cell carcinoma ablation

Journal Pre-proof Survival and functional outcomes of patients who underwent facial-submental artery island flap reconstruction after oral cavity or HPV-negative oropharyngeal squamous cell carcinoma ablation Wei-liang Chen You-yuan Wang Bin Zhou Zuo-zheng Wen Kai-fang Yuan Yong-ju Chen

PII:

S2468-7855(19)30286-1

DOI:

https://doi.org/doi:10.1016/j.jormas.2019.11.003

Reference:

JORMAS 770

To appear in:

Journal of Stomatology oral and Maxillofacial Surgery

Received Date:

13 July 2019

Accepted Date:

20 November 2019

Please cite this article as: Wei-liang ChenYou-yuan WangBin ZhouZuo-zheng WenKai-fang YuanYong-ju Chen Survival and functional outcomes of patients who underwent facial-submental artery island flap reconstruction after oral cavity or HPV-negative oropharyngeal squamous cell carcinoma ablation (2019), doi: https://doi.org/10.1016/j.jormas.2019.11.003

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Survival and functional outcomes of patients who underwent facialsubmental artery island flap reconstruction after oral cavity or HPVnegative oropharyngeal squamous cell carcinoma ablation Wei-liang Chen, DDS, MD, MBAa,1; You-yuan Wang, DDS, PhDb,1; Bin Zhou, DDS, PhDc; Zuo-zheng Wend; Kai-fang Yuan, DDSe; Yong-ju Chen DDSf a

Professor and Director, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China

c

Associated Professor

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b

Attending

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Attending

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Attending

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Attending Shared first authorship.

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Correspondence and requests for offprints to: Professor and Director Dr Wei-liang Chen,

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Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University. 107 Yan-jiang Road, 510120 Guangzhou, China.

Tel: +86 020 81332429

Fax: +86 020 81332853

E-mail:[email protected] Abstract The purpose of this study was to evaluate the outcomes of survival and functional outcome of patients with Oral cavity squamous cell carcinoma (OCSCC) and HPVnegative oropharyngeal squamous cell carcinoma (HPV-negative OPSCC) using 1

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FSAIF reconstruction of the defects. The 275 patients were divided into OCSCC and HPV-negative OPSCC group were treated with surgery and oral cavity and oropharynx reconstruction with the FSAIF. The skin paddles in the OCSCC and OPSCC groups were 3 × 9 to 5 × 14 cm and 3 × 8 to 5 × 15 cm, respectively. The original primary tumor site was the oral cavity in 203 patients and the oropharynx in 72. No significant differences TNM or clinical stage, skin paddle of the flap, rate of flap failure, or local complications were observed between the OCSCC and HPVnegative OPSCC groups. Ten flap failures occurred, yielding a success rate of 96.4%.

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There are not differences of survival and speech function of patients with OCSCC and HPV--negative OPSCC using FSAIFs reconstruction of the defects following cancer ablation, but there are differences of the swallowing function. This flap is suitable for

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reconstructing the defect in the oral cavity or oropharynx.

Keywords: Oral cavity; oropharynx; squamous cell carcinoma; HPV-negative;

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submental flap; pedicle flap

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Introduction

Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy of

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the head and neck. It is important for clinicians to identify differences in treatment outcomes between patients with OCSCC and those with oropharyngeal squamous cell carcinoma (OPSCC). However, few reports have compared the survival and functional outcomes of patients with OCSCC and those with OPSCC. Anatomically, the oral cavity includes the lips, gingiva, retromolar trigone, hard palate, buccal mucosa, mobile tongue, and floor of the mouth, whereas the oropharynx includes the palatine tonsils, soft palate, tongue base, and posterior pharyngeal wall. Although the oral cavity and oropharynx form one continuous chamber lined by an uninterrupted stratified squamous epithelium and historical convention has grouped them together under the blanket term “oral”, they are dissimilar in many important respects. Most notable is the presence of tonsillar tissue in the oropharynx and its absence in the oral cavity1. We reported previously that the facial-submental artery island flap (FSAIF) can be used reliably to reconstruct oral and maxillofacial defects following cancer 2

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ablation2. The flap is an underused alternative to reconstruct head and neck defects after tumor ablation and a viable surgical option compared with the forearm free flap; it is considered oncologically safe in the N0 neck, allowing an excellent esthetic reconstruction, with decreased operative time, hospital stay, and donor site morbidity 3

. Recent trends have shown a dramatic rise in the incidence of OPSCC, with a

marked increase in lesions related to human papillomavirus (HPV) infection4 and HPV association is the most important predictor for surgically treated patients with OPSCC5. However, this study compared the survival and functional outcomes of

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patients with OC-SCC and HPV-negative OPSCC who underwent FSAIF reconstruction of the defects following cancer ablation. Patients and methods

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This retrospective chart review was conducted from January 2011 to September

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2018 at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The patients included 180 men and 95 women ranging in age from 23 to 81 years (median, 57.5

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years). They were divided into OCSCC and HPV-negative OPSCC group were treated with surgery including resection of the cancer or plus marginal mandibulectomy,

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ipsilateral or bilateral selective neck dissections (SND), and OC and OP reconstruction with the FSAIFs. We collected data on age, sex, TNM stage, flap size, overall flap survival, and survival status. The cases of lack of follow-up data and HPV-positive determined by HPV-DNA detection and p16INK4a immunohistochemistry were excluded. They were treated with surgery, including resection of the cancer or plus marginal mandibulectomy, ipsilateral or bilateral selective neck dissections (SND), and underwent oral cavity or oropharynx reconstruction using an FSAIF. Clear margins were obtained in all patients. The skin paddles (cm) in the OCSCC and HPV-negative OPSCC groups were 3 × 9 to 5 × 14 cm (median: 3.8 × 11.7 cm) and 3 × 8 to 5 × 15 cm (median: 3.8 × 11.8 cm), respectively. The FSAIF based on the distal facial pedicle was used to repair the defect in the oral cavity or oropharynx through a subcutaneous tunnel following radical resection. The donor area was largely closed. The details of the surgical 3

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technique were described in our previous report6. The submandibular nodes were checked in all patients during flap elevation and were found to be pathologically negative. The original primary tumor site was the oral cavity in 203 patients (73.8%), including the tongue in 96 cases (Fig. 1), the hard palate in 58 cases (Fig. 2), the floor of the mouth in 24 cases (Fig. 3), the gingiva in 13 cases (Fig. 4), and the buccal mucosa in 12 cases (Fig. 5). The original primary tumor site was the oropharynx in 72 cases (26.2%), including the palatine tonsils in 20 cases (Fig. 6), the tongue base in 24 cases (Fig. 7), and the soft palate in 18 cases (Fig. 8). According to the 2017

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American Joint Committee on Cancer staging guidelines7, the clinical stages of SCC were I, II, III, and IV in 17 (8.4%), 153 (75.3%), 25 (12.3%), and 8 (4.0%) cases, respectively, and 4 (5.6%), 48 (66.7%), 14 (19.4%), and 6 (8.3%) cases, respectively,

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in the OCSCC and HPV-negative OPSCC groups. Thirty-eight patients with stage IV or III cancers were treated with adjuvant radiotherapy. All patients were followed to

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determine swallowing and speech functions by a panel of three surgeons. Swallowing was classified as normal, soft, liquid, or nasogastric tube feeding; speech was

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Statistical Analysis

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classified as normal, intelligible, slurred, or tracheostomy required.

The statistical analysis was performed using SPSS 20.0 software (IBM Corp., Armonk, NY, USA). The chi-square test, independent sample t-test, and Mann– Whitney U test were used to analyze the data, and the level of significance was set at P < .05.

Results

No significant differences were found in tumor-node-metastasis (TNM) or clinical staging, the skin paddle of the flap, the rate of flap failure, or local complications between the OCSCC and HPV-negative OPSCC groups (P > 0.05). However, significant differences were observed in sex between the groups (P < 0.05). The oral cavity and oropharynx defects in all patients were reconstructed using an FSAIF. No major complications developed in any patient. Ten flap failures occurred, yielding a 4

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success rate of 96.4%, and no significant difference was observed in the rate of flap failure between the OCSCC (3.5%, 7/203) and HPV-negative OPSCC groups (4.2%, 3/72). Hemorrhage, orocutaneous fistulas, and dehiscence at the donor site occurred in nine (4.4%), six (3.0%), and five (2.4%) cases in the OCSCC group and five (6.5%), four (4.4%), and two (2.8%) cases in the HPV-negative OPSCC group. Surgery was performed to stop the bleeding when hemorrhage occurred. Flap failures, orocutaneous fistulas, and dehiscence at the donor site were treated successfully with debridement.

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All patients were evaluated at 6 months postoperatively. Significant differences in swallowing outcomes were observed between the OCSCC and HPV-negative OPSCC groups (P < 0.05). Overall, 129 (63.5%) were eating normally, 62 (30.0%) had a soft

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diet, 12 (5.9%) remained on a liquid diet, and none required tube feeding in the OCSCC group. In comparison, 24 patients (33.3%) were eating normally, 22 (30.1%)

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had a soft diet, 21 (29.2%) had a liquid diet, and 5 (6.9%) required tube feeding in the

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HPV-negative OPSCC group. Moreover, 164 patients (59.6%) achieved normal speech, 84 (30.5%) achieved intelligible speech, 27 (9.8%) achieved slurred speech, and none required a permanent tracheostomy. No differences (P > 0.05) were

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observed in speech outcomes between the groups. The patients were followed for 9–59 months (median, 30.2 and 31.3 months in the in the OCSCC and HPV-negative OPSCC groups, respectively). At the final followup, 214 (77.8%) patients were alive with no evidence of disease (79.8% and 72.2% in the OCSCC and HPV-negative OPSCC groups, respectively), 33 (12.0%) patients were alive with disease (11.8% and 12.5%, respectively), and 28 (10.2%) patients had died of local recurrence or distant metastases (8.1% and 15.3%, respectively). No significant survival difference (P > 0.05) was observed between the groups. Table 1 summarizes the data for the two age groups.

Discussion

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The goals of oral cavity and oropharynx defect reconstruction following cancer ablation are to restore the shape and volume of the oral cavity and oropharynx anatomically, recover normal swallowing and speech, and extend the life span. It is important for clinicians to identify differences in the treatment outcomes between patients with OCSCC and HPV-negative OPSCC. In our series, 275 patients with an OCSCC or HPV-negative OPSCC were treated successfully with surgery, including resection of the cancer or pulse marginal mandibulectomy with ipsilateral or bilateral SND, and those defects were reconstructed with an FSAIF. Clear margins were

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obtained in all patients, and the submandibular nodes were checked in all patients during flap elevation and were found to be pathologically negative. Comparing the survival outcomes of the patients with OCSCC and HPV-negative OPSCC, our results

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showed no significant survival difference between the groups. The outcome data of a prospective audit showed that 481 patients had SCC with a 5-year disease-specific

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survival (DSS) of 50% and an overall survival of 35%; in addition, the 5-year DSS

respectively 8.

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rates were 67% and 62% in 249 patients with OCSCC and 132 with OPSCC,

Our results show that no differences in speech outcomes were observed between

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the groups; 33.3% patients were eating normally, 30.1% had a soft diet, 29.2% had a liquid diet, and 6.9% required tube feeding in the HPV-negative OPSCC group. In the OCSCC group, 63.5% patients 63.5% were eating normally, 30.0% had a soft diet, 5.9% remained on a liquid diet, and none required tube feeding. In addition, significant differences in swallowing outcomes were observed between the HPVnegative OPSCC and OCSCC groups, indicating that the oral cavity and oropharynx are different anatomically, and the oropharynx is more anatomically complex than the oral cavity. It is important for clinicians to identify differences in treatment outcomes related to swallowing between patients with OCSCC and HPV-negative OPSCC, and multidisciplinary care should be provided to optimize the swallowing outcomes for patients with HPV-negative OPSCCs.

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The success rate of the surgery was 96.4%. No significant difference was observed in the rate of flap failure between the OCSCC and HPV-negative OPSCC groups. Flap failure occurred in patients with comorbid conditions, including cardiovascular and blood diseases, which may have been the cause of hemorrhage when pressing the pedicle and infusing the flap. The average skin paddle was 3.8 × 11.8 cm, which was suitable to repair the oral cavity and oropharynx defects because of its excellent flexibility. The soft palate is a pharyngopalatal structure that plays pivotal roles in speech, swallowing, and mastication, and soft palate reconstruction represents one of

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the greatest challenges in the surgical rehabilitation of patients with HPV-negative OPSCC. Satisfactory results in swallowing and speech function can be achieved using folded FSAIF reconstruction for soft palate defects following cancer ablation9. In

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addition, the reverse facial artery-submental artery mandibular osteomuscular flap with titanium dental implants may be reliable for the functional reconstruction of

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maxillary defects10. The FSAIF is a reliable and versatile flap for head and neck reconstruction. Its minimal donor site morbidity, excellent cosmetic match, pliability,

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and relative ease of dissection and application have definite advantages over distant flaps, making it an excellent addition to the reconstructive armamentarium of the head

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and neck surgeon11. Although the results of this study showed no significant survival difference between the OCSCC and HPV-negative OPSCC groups, it is generally considered that the prognosis of HPV-negative OPSCC was relatively poor. The smoking history, drinking history, tumor staging, pathological difference in SCC, and expression of p16 protein may be significant prognostic factors for OCSCC and OPSCC. A study examined the prognostic significance of HPV in patients with an OPSCC or OCSCC, and the results showed that HPV was common in both OPSCC and OCSCC and was associated with a better survival outcome in OPSCC but not in OCSCC patients12. Primary surgical treatment may be associated with improved outcomes in patients with T4 OPSCC. The p16 immunohistochemical status remains a strong prognostic indicator even in patients with locally advanced disease13. Therefore, we will study the survival of patients undergoing FSAIF reconstruction after HPV-negative and HPV-positive OPSCC ablation in the future. 7

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Conventionally, the forearm flap or anterolateral high flap is considered suitable for the reconstruction of the OC and OP. It believed that the FSAIF is an surgically sound option for reconstruction of oral and maxillary defects14,15. This flap can be easily raised and involves shorter operative time and hospital stay compared to the free-flap procedure. It can be an excellent choice in patients with a high ASA risk score, moreover in elderly patients, where the potential complications linked to microsurgical procedures are avoided16 and also this flap offers an excellent alternative to more labour intensive and costly free flap alternatives3,17. Recently, it

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has been considered that the FSAIF is a robust and reliable novel flap and on par with submental artery perforator flaps for reconstruction of small and medium-sized intraoral defects18 and a reliable and safe method for repairing Brown class II

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maxillary defects following cancer ablation, particularly in older patients19. In conclusion, there are not differences of survival and speech function of patients

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with OC-SCC and HPV-negative OPSCC using FSAIFs reconstruction of the defects

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following cancer ablation, but the swallowing function of the HPV-negative OPSCC group was worse than that of the OCSCC group. The FSAIF is a reliable and versatile flap for OC and OP reconstruction. Its minimal donor site morbidity and

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relative ease of dissection and application has a definite advantage over distant flaps, making it an excellent addition to the reconstructive armamentarium of the head and neck surgeon. Declarations

Funding: This work was supported by grants from the National Natural Science Foundation of China (no. 81772888 to Wei-liang Chen；no. 81702695 to Bin Zhou) Competing Interests: None declared. Ethical Approval: Not required Patient Consent: Patient consent obtained 8

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References 1. Westra WH, Lewis JS Jr. Update from the 4th edition of the World Health Organization classification of head and neck tumours: Oropharynx. Head Neck Pathol. 2017;11(1):41–7. 2. Chen WL, Li JS, Yang ZH, Huang ZQ, Wang JU, Zhang B. Two submental island flaps for reconstructing oral and maxillofacial defects following cancer ablation. J Oral Maxillofac Surg. 2008;66(6):1145–56.

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3. Aslam-Pervez N, Caldroney SJ, Isaiah A, Lubek JE. A retrospective volume matched analysis of the submental artery island pedicled flap as compared to the forearm free flap: Is it a good alternative choice for the reconstruction of defects of the oral cavity and oropharynx? J Oral Maxillofac Surg. 2018;76(3):656–63. 4. Chi AC, Day TA, Neville BW. Oral cavity and oropharyngeal squamous cell carcinoma--an update. CA Cancer J Clin. 2015;65(5):401–21.

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5. Wagner S, Wittekindt C, Sharma SJ, Wuerdemann N, Jüttner T, Reuschenbach M, Prigge ES, von Knebel Doeberitz M, Gattenlöhner S, Burkhardt E, PonsKühnemann J, Klussmann JP. Human papillomavirus association is the most important predictor for surgically treated patients with oropharyngeal cancer. Br J Cancer. 2017;116(12):1604-1611.

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6. Chen WL, Li JS, Yang ZH, Huang ZQ, Wang JU, Zhang B. Two submental island flaps for reconstructing oral and maxillofacial defects following cancer ablation. J Oral Maxillofac Surg. 2008;66(6):1145-56. 7. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JD, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gress DM, Meyer LR. AJCC (2017) Cancer Staging Manual. Springer International Publishing: New York, NY, USA, 2017. 8. McMahon JD, Robertson GA, Liew C, McManners J, Mackenzie FR, Hislop WS, Morley SE, Devine J, Carton AT, Harvey S, Hunter K, Robertson AG. Oral and oropharyngeal cancer in the West of Scotland-long-term outcome data of a prospective audit 1999-2001. Br J Oral Maxillofac Surg. 2011;49(2):92–8. 9. Zhang DM, Chen WL, Lin ZY, Yang ZH. Use of a folded reverse facial-submental artery submental island flap to reconstruct soft palate defects following cancer ablation. J Craniomaxillofac Surg. 2014;42(6):910–4. 10. Chen WL, Zhou M, Ye JT, Yang ZH, Zhang DM. Maxillary functional reconstruction using a reverse facial artery-submental artery mandibular 9

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osteomuscular flap with dental implants. J Oral Maxillofac Surg. 2011;69(11):2909–14. 11. Parmar PS, Goldstein DP. The submental island flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2009;17(4):263–6. 12. Lai K, Matthews, Wilmott JS, Killingsworth MC, Yong JL, Caixeiro NJ, Wykes, Samakeh A, Forstner D, Lee M, McGuinness J, Niles N, Hong A, Ebrahimi A, Lee CS. Differences in LC3B expression and prognostic implications in oropharyngeal and oral cavity squamous cell carcinoma patients. BMC Cancer. 2018;18(1):624.

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13. Zenga J, Wilson M, Adkins DR, Gay HA, Haughey BH, Kallogjeri D, Michel LS, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Treatment outcomes for T4 oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1118–27.

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14. Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free flap for oral reconstruction: comparison of outcomes. Arch Otolaryngol Head Neck Surg. 2011;137(1):82-7.

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15. Patel AV, Thuener JE, Clancy K, Ascha M, Manzoor NF, Zender CA. Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects: Comparison of outcomes and patient factors. Oral Oncol. 2018;78:194-199.

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16. Schonauer F, Di Martino A, Nele G, Santoro M, Dell'Aversana Orabona G, Califano L. Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly. Int J Surg. 2016 Sep;33 Suppl 1:S51-6. 17. Forner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. J Otolaryngol Head Neck Surg. 2016;45:11. 18. Ou XR, Su T, Huang L, Jiang CH, Guo F, Li N, Min AJ, Jian XC. A comparative study between submandibular-facial artery island flaps (including perforator flap) and submental artery perforator flap: A novel flap in oral cavity reconstruction. Oral Oncol. 201924;99:104446. 19. Pan CB, Wang Y, Chen WL, Zhou B, Wang XM. Outcomes of younger and older patients with palatal cancer undergoing pedicled facial-submental artery island flap reconstruction. Int J Oral Maxillofac Surg. 2019 Jun 18. pii: S09015027(19)31159-2. doi: 10.1016/j.ijom.2019.05.002. [Epub ahead of print] 10

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Legend

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Figure. 1. A 52-year-old male patient with stage II tongue squamous cell carcinoma (SCC); before operation (A), the facial-submental artery island flap (FASIF) was

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harvested (B), and View of the repaired tongue defect with the at 48 months postoperatively (C).

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Figure 2. A 414-year-old female patient with stage II palatal SCC; The incision used to harvest the FASIF (A), reconstruction of maxillectomy defects after radical

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resection (B), and the photograph was taken 18 months postoperatively (C).

Figure 3. The FASIF are used to reconstruction of floor of the mouth defects

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following cancer ablation. A 48-year-old male patient with a stage II SCC of floor of

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the mouth (A), the photograph was taken 9 months postoperatively (B); and the flap are used to repair the defect in a 78-year-old male patient with stage II SCC of floor

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of the mouth (C) and the photograph was taken 59 months postoperatively (D).

Figure 4. A 61-year-old female patient with stage II gingiva SCC. The incision of the gingiva tumor (A) and the surgery including resection of the cancer plus marginal

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mandibulectomy are shown (B); the FASIF was harvested (C); View of the repaired oral defect 58 months postoperatively (D).

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Figure 5. A 56-year-old male patient with stage II buccal mucosa SCC. View of the

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repaired oral defect 49 months postoperatively (A) and a well-hidden scar at the donor

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site (B and C).

Figure 6. A 74-year-old male patient with stage II palatine tonsils SCC. Before operation (A); the oropharyngeal defects following cancer ablation (B) and a view of the defect repaired using an FASIF (C); an apparent at the oropharynx 48 months postoperatively (D). 13

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Figure7. A 38-year-old male patient with stage II tongue base SCC. the oropharyngeal

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defects following cancer ablation (A) and a view of the defect repaired using an FASIF (B); Tongue the specimen of tumor the tongue base (C); an apparent at the

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oropharynx 8 months postoperatively (D).

Figure 8. A 74-year-old male patient with stage II soft palate SCC. The foldable flap was created by removing a 1.0-cm-wide band of skin (A); out line of the dissection of soft palate tumor (B); the oropharyngeal defects following cancer ablation (C); the flap rotated into the postablative defect and the distal portion of the folded flap was

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turned to serve as the nasal plane, and the medial portion served as the oral plane (D);

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an apparent at the oropharynx 8 months postoperatively (E).

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Table 1. Demographics, clinical characteristics, and outcomes of outcome of patients with oral cavity (OC) and HPV-negative oropharyngeal squamous cell carcinoma (HPV-negative OPSCC) using facial-submental artery island flap reconstruction of the defects following cancer ablation OCSCC (n = 203) No. of patients (%) Age range, years (mean ± SD)

23–81, 56.3±12.6

HPV-negative OPSCC (n =72)

P-value

No. of patients (%) 35–81, 62.4±7.9

.625 .044

Sex 122 (60.1)

Female

81 (39.9)

14 (19.4)

T2

162 (79.8)

T3

24 (11.8)

10 (13.9)

T4

0 (0.0)

0 (0.0)

170 (83.7)

52 (72.2)

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17 (8.4)

N1 N2

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57 (79.2)

25 (12.3)

14 (19.4)

8 (4.0)

6（8.4）

0 (0.0)

0 (0.0)

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N0

.847

AJCC tumor stage Stage I

17 (8.4)

4 (5.6)

Stage II

153 (75.3)

48 (66.7)

Stage III

25 (12.3)

Stage IV

Marginal mandibulectomy

Selective neck dissection (SND)

.765

5 (6.9)

T1

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TNM stage

58 (80.6)

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Male

8 (4.0)

14 (19.4) 6 (8.3)

25（12.3）

23（31.9）

179（88.2）

50 (69.4)

.085 .325

Ipsilateral SND Bilateral SND

24（11.8）

22 (30.6) > .99

Paddle size Range, median (cm)

3 × 9 to 5 × 14, 3.8 × 11.7

3 × 8 to 5 × 15, 3.8 × 11.8

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OCSCC (n = 203) No. of patients (%) Age range, years (mean ± SD)

23–81, 56.3±12.6 196 (96.5)

Successes (no.)

HPV-negative OPSCC (n =72)

35–81, 62.4±7.9

.625

69 (95.8)

>.99 .868

Local complications Hemorrhage

9 (4.4)

5 (6.9)

Orocutaneous fistula

6 (3.0)

3 (4.4)

Dehiscence in donor-site

5 (2.4)

2 (2.8)

25 (12.3)

Swallowing

129 (63.5)

24 (33.3)

Soft

62 (30.0)

22 (30.1)

Liquid

-p

Normal

13 (18.1)

ro of

Adjuvant treatment, radiotherapy

12 (5.9)

21 (29.2)

0 (0.0)

5 (6.9)

re

Nasogastric tube feeding Speech

133 (65.5)

Slurred

lP

Normal Intelligible

P-value

No. of patients (%)

Jo ur na

Follow-up range, median (months)

.046

.179 31 (43.1)

61 (30.1)

23 (31.9)

9 (4.4)

18 (25.0)

9~58, 30.2

.823

8~59, 31.3

.892 .497

Status

Alive with no disease

162 (79.8)

Alive with disease locale + regional relapse

18+6 (11.8) 17 (8.4)

Died of disease

52 (72.2) 6+3 (12.5) 11 (15.3)

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