Results of using revascularized flaps in patients with oral cancer after neoadjuvant chemotherapy

Introduction. In Russia, cancer of the oral mucosa is diagnosed in more than 9500 patients every year. In 65–70 % of cases, the disease is diagnosed at stages III–IV. Despite the use of combination treatment, prognosis in patients with stage III and IVA oral mucosa cancer remains unfavorable. Neoadjuvant chemotherapy is considered a strategy to decrease the risk of distant metastasis, decrease tumor volume, and affect the status of surgical resection margins.
Aim. To evaluate the results of using revascularized flaps in patients with resectable stage III and IVA cancer of the oral mucosa who received neoadjuvant chemotherapy.
Materials and methods. Retrospective analysis of data of 41 patients who underwent surgery in 2020–2023 at the Republican Clinical Oncological Dispensary (Ufa) was performed. All patients underwent R0 resection with subsequent defect reconstruction using revascularized flaps. Two groups were compared: primary patients (n = 31) and patients who received neoadjuvant therapy per the DCF (docetaxel, cisplatin, 5‑fluorouracil) (n = 10) scheme.
Results. Overall rate of complications in the groups of primary patients and patients receiving neoadjuvant therapy per the DCF scheme was 16.1 and 20 %, respectively (p = 0.398), however the rate of flap loss was significantly higher in patients who underwent neoadjuvant chemotherapy: 40 % versus 9.7 % (p = 0.047). Recurrence rate in the neoadjuvant chemotherapy group was 10 %, in the group without neoadjuvant therapy it was 38.7 % (p = 0.129).
Conclusion. Neoadjuvant chemotherapy can be associated with higher risk of microvascular complications and flap loss but it decreases the recurrence rate. Therefore, further search for the optimal treatment strategy for patients with cancer of the oral mucosa is necessary.

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