Comparing Functional Outcomes With and Without Free Flap Reconstruction Following TORS in T1/T2 HPV+ OPSCC

Sunday, September 29, 2024

8:00 AM – 8:06 AM EDT

Location: MBCC, 208

Disclosure(s):

Praneet Chandra Kaki, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Robert M. Brody, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Steven B. Cannady, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Free flap reconstruction (FFR) for oropharyngeal malignancies following transoral robotic surgery (TORS) is usually reserved for large, complex defects. In the setting of a retropharyngeal carotid artery, FFR may be performed for small T1-2 tumors to provide vessel coverage. We compared T1-2 HPV+ oropharyngeal squamous cell carcinoma (HPV+ OPSCC) with and without FFR to clarify the functional swallowing outcomes of FFR for small primary defects.

Methods: Retrospective cohort study of pT1-2 HPV+ OPSCC patients who underwent TORS from 2010-2022. Patients were categorized based on whether or not FFR was performed (FFR vs nFFR). A propensity score match (PSM) was performed to match for staging, treatment, and demographics. Functional Oral Intake Scale (FOIS), graded from 1 (no oral intake) to 7 (no restrictions), characterized swallowing outcomes. Statistical analysis was performed in R.

Results: After PSM, 93 patients met the inclusion criteria (59.8 years old, 92% White, 88% male). 31 (33%) underwent FFR, 77 (83%) had pT2 tumors, and 87 (93%) underwent adjuvant treatment. The FFR cohort saw an increased return to the OR (FFR 19% vs nFFR 3.3%, p< 0.001) and mean hospital stay (4.9±3.06 vs 7.2±2.20 days, p=0.02). Time to Dobhoff tube removal and 30-day readmissions were similar.

Median pre-operative FOIS was similar between groups (FFR: 7.00[IQR 6.00,7.00] vs nFFR: 7.0[7.00,7.00], p = 0.2) with comparable decline at first follow-up (4.00[2.00,4.00] vs 2.00[2.00,3.00], p=0.2). The nFFR cohort had higher FOIS at 3 months and 6 months (5.00[5.00,6.00] vs 6.00[5.00,7.00], p=0.04). FOIS was similar after 1 year (6.00[5.00,7.00] vs 6.00[6.00,7.00], p=0.3). There were no differences in rates of PEG insertion, trismus, velopharyngeal insufficiency, aspiration, or xerostomia.

Conclusions: Although FFR led to a slower short-term recovery in oral intake, differences are not clinically significant considering comparable functional outcomes to nFFR at 1 year. However, FFR for pT1-2 tumors should not be performed without a clear indication as it carries increased risk of OR returns and longer hospital stays.

Presenting Author(s)

Praneet C. Kaki, BS

Medical Student
Sidney Kimmel Medical College, Thomas Jefferson University
Kendall Park, New Jersey, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

NS

Neel R. Sangal, MD

Resident Physician
University of Pennsylvania Department of Otolaryngology
Phiiladelphia, PA, United States

Disclosure information not submitted.
DL

Doreen W. Lam, MD

Resident
Cleveland Clinic Head and Neck Institute
Cleveland, OH, United States

Disclosure information not submitted.
Robert M. Brody, MD

Assistant Professor
Department of Otorhinolaryngology Head and Neck Surgery, Hospital of the University of Pennsylvania
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SC

Steven B. Cannady, MD

Associate Professor
Department of Otorhinolaryngology Head and Neck Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

SC

Steven B. Cannady, MD

Associate Professor
Department of Otorhinolaryngology Head and Neck Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.