Flap Reconstruction Results in Longer Overall Treatment Time in Patients Treated With Surgery and Adjuvant Radiotherapy for Carcinoma of the Oral Cavity and Larynx

Objective: There is an inverse relationship between cancer cure and overall treatment time (OTT) in patients treated with surgical resection and radiotherapy (RT). Methods: OTT was evaluated based on the reconstruction procedure in 420 patients with oral cavity and larynx cancers treated with surgery and RT between 1991 and 2020. Results: With OTT >85 days, the difference between no versus yes flap reconstruction was similar to 20 percentage points and significant for all comparisons: primary closure (+/- skin graft), 49%, vs. rotation or free flap, 71% (P<0.0001); primary closure (+/- skin graft), 49%, versus free flap without bone, 66% (P=0.0358); and primary closure (+/- skin graft), 49%, versus free flap with bone, 82% (P<0.0001). Conclusions: The use of flap reconstructions results in substantial increases in OTT. Findings suggest a need to reevaluate current policies regarding the choice of reconstruction and starting RT sooner after surgery.