Pradyumna Herle1, Lipi Shukla, Wayne A Morrison, Ramin Shayan. 1. Regenerative Surgery Group, Australian Catholic University and O'Brien Institute Regenerative Tissue Engineering Centre (AORTEC), Melbourne, Victoria, Australia.
Abstract
BACKGROUND: There is a general consensus among reconstructive surgeons that preoperative radiotherapy is associated with a higher risk of flap failure and complications in head and neck surgery. Opinion is also divided regarding the effects of radiation dose on free flap outcomes and timing of preoperative radiation to minimize adverse outcomes. Our meta-analysis will attempt to address these issues. METHOD: A systematic review of the literature was conducted in concordance to PRISMA protocol. Data were combined using STATA 12 and Open Meta-Analyst software programmes. RESULTS: Twenty-four studies were included comparing 2842 flaps performed in irradiated fields and 3491 flaps performed in non-irradiated fields. Meta-analysis yielded statistically significant risk ratios for flap failure (RR 1.48, P = 0.004), complications (RR 1.84, P < 0.001), reoperation (RR 2.06, P < 0.001) and fistula (RR 2.05, P < 0.001). Mean radiation dose demonstrated a trend towards increased risk of flap failure, but this was not statistically significant. On subgroup analysis, flaps with >60 Gy radiation had a non-statistically significant higher risk of flap failure (RR 1.61, P = 0.145). CONCLUSION: Preoperative radiation is associated with a statistically significant increased risk of flap complications, failure and fistula. Preoperative radiation in excess of 60 Gy after radiotherapy represents a potential risk factor for increased flap loss and should be avoided where possible.
BACKGROUND: There is a general consensus among reconstructive surgeons that preoperative radiotherapy is associated with a higher risk of flap failure and complications in head and neck surgery. Opinion is also divided regarding the effects of radiation dose on free flap outcomes and timing of preoperative radiation to minimize adverse outcomes. Our meta-analysis will attempt to address these issues. METHOD: A systematic review of the literature was conducted in concordance to PRISMA protocol. Data were combined using STATA 12 and Open Meta-Analyst software programmes. RESULTS: Twenty-four studies were included comparing 2842 flaps performed in irradiated fields and 3491 flaps performed in non-irradiated fields. Meta-analysis yielded statistically significant risk ratios for flap failure (RR 1.48, P = 0.004), complications (RR 1.84, P < 0.001), reoperation (RR 2.06, P < 0.001) and fistula (RR 2.05, P < 0.001). Mean radiation dose demonstrated a trend towards increased risk of flap failure, but this was not statistically significant. On subgroup analysis, flaps with >60 Gy radiation had a non-statistically significant higher risk of flap failure (RR 1.61, P = 0.145). CONCLUSION: Preoperative radiation is associated with a statistically significant increased risk of flap complications, failure and fistula. Preoperative radiation in excess of 60 Gy after radiotherapy represents a potential risk factor for increased flap loss and should be avoided where possible.
Authors: Nikhil Sobti; Kaleem S Ahmed; Thais Polanco; Marina Chilov; Marc A Cohen; Jay Boyle; Farooq Shahzad; Evan Matros; Jonas A Nelson; Robert J Allen Journal: J Plast Reconstr Aesthet Surg Date: 2022-05-06 Impact factor: 3.022
Authors: Amit Walia; Jake J Lee; Ryan S Jackson; Angela C Hardi; Craig A Bollig; Evan M Graboyes; Joseph Zenga; Sidharth V Puram; Patrik Pipkorn Journal: Otolaryngol Head Neck Surg Date: 2021-09-07 Impact factor: 5.591
Authors: C Copelli; K Tewfik; L Cassano; N Pederneschi; S Catanzaro; A Manfuso; R Cocchi Journal: Acta Otorhinolaryngol Ital Date: 2017-10 Impact factor: 2.124
Authors: Suzanne M Eken; Tinna Christersdottir; Greg Winski; Traimate Sangsuwan; Hong Jin; Ekaterina Chernogubova; John Pirault; Changyan Sun; Nancy Simon; Hanna Winter; Alexandra Backlund; Siamak Haghdoost; Göran K Hansson; Martin Halle; Lars Maegdefessel Journal: JACC Basic Transl Sci Date: 2019-02-25
Authors: Muhammad Faisal; Peter D Berend; Rudolf Seemann; Stefan Janik; Stefan Grasl; Andrea Ritzengruber; Herbert Mendel; Arif Jamshed; Raza Hussain; Boban M Erovic Journal: Cancers (Basel) Date: 2021-05-19 Impact factor: 6.639