Low skeletal muscle mass is a strong predictive factor for surgical complications and a prognostic factor in oral cancer patients undergoing mandibular reconstruction with a free fibula flap

被引:57
作者
Ansari, E. [1 ]
Chargi, N. [1 ]
van Gemert, J. T. M. [1 ]
van Es, R. J. J. [1 ,2 ]
Dieleman, F. J. [1 ]
Rosenberg, A. J. W. P. [2 ]
Van Cann, E. M. [1 ,2 ]
de Bree, R. [1 ]
机构
[1] Univ Med Ctr Utrecht, UMC Utrecht Canc Ctr, Dept Head & Neck Surg Oncol, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Oral & Maxillofacial Surg, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
关键词
Free fibula flap; Microvascular reconstruction; Mandibular reconstruction; Body composition; Sarcopenia; Skeletal muscle mass; Head and neck cancer; SOLID TUMORS; RISK-FACTORS; SARCOPENIA; HEAD; SURVIVAL; CACHEXIA; SURGERY; ADULTS;
D O I
10.1016/j.oraloncology.2019.104530
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Fibula free flaps (FFF) are effective in accomplishing successful reconstruction for segmental defects of the mandible. Potential risk factors for FFF complications have been described in previous research, e.g. age, comorbidity and smoking. Low skeletal muscle mass (SMM) has shown to be an emerging predictive factor for complications and prognostic factor for survival in head and neck cancer. This study aims to identify the predictive and prognostic value of low SMM for surgical FFF related complications, postoperative complications and survival in patients who underwent mandibular reconstruction with FFF after oral cavity cancer resection. Materials and methods: A retrospective study was performed between 2002 and 2018. Pre-treatment SMM was measured at the level of the third cervical vertebra and converted to SMM at the level of the third lumbar vertebra (L3). SMM at the level of L3 was corrected for squared height. Low SMM was defined as a lumbar skeletal muscle index (LSMI) below 43.2 cm(2)/m(2). Results: 78 patients were included, of which 48 (61.5%) had low SMM. Low SMM was associated with an increased risk of FFF related complications (HR 4.3; p = 0.02) and severe postoperative complications (Clavien-Dindo grade III-IV) (HR 4.0; p = 0.02). In addition low SMM was a prognosticator for overall survival (HR 2.4; p = 0.02) independent of age at time of operation, ACE-27 score and TNM stage. Conclusion: Low SMM is a strong predictive factor for FFF reconstruction complications and other postoperative complications in patients undergoing FFF reconstruction of the mandible. Low SMM is also prognostic for decreased overall survival.
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页数:7
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