Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Outcomes of primary and metastatic oral cavity squamous cell carcinoma following head and neck surgery (1740)

Sabrina P Koh 1 2 , Rahul Jayakar 1 , Craig A MacKinnon 1 , Fiona Smithers 1 , Swee T Tan 1 2
  1. Wellington Regional Plastic, Maxillofacial & Burns Unit , Hutt Hospital , Wellington, New Zealand
  2. Gillies McIndoe Research Institute, Wellington, New Zealand

Background Metastatic disease is a negative prognostic factor for survival in oral cavity squamous cell carcinoma (OCSCC). We reviewed survival and recurrence outcomes for patients undergoing major head and neck surgery for OCSCC at Hutt Hospital in those with primary and metastatic disease to the neck. We identified potential high risk prognostic features for recurrence and survival.

Methods Patients with primary and metastatic OCSCC undergoing major head and neck surgery between 1996-2022 at Hutt Hospital were identified from our Head and Neck Database. Primary outcome measures included recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS), with comparisons made between those with primary and metastatic disease. Univariate analysis was performed to identify potential negative prognostic features for survival and recurrence. 

Results 348 patients were included. 91 had metastatic disease. Median RFS was 90 months, with no significant difference between primary and metastatic disease (94.6 vs 81.0 months, p=0.935). Median OS was 92.0 months, with no difference between primary and metastatic disease (79 vs 100 months, p=0.574). Median CSS was 122 months, with no significant difference between primary and metastatic disease (134 vs 115 months, p=0.258). Negative prognostic factors for OS and CSS included T-stage (p=0.028) and comorbidities (p<0.001). 189 patients underwent free flap reconstruction. Ulnar forearm was the most common (63%), followed by the fibula (19%). 80 patients had complications requiring return to theatre, 36.3% for hematoma and 21.2% for flap complications. 

Conclusion Since 1996, 348 major operations have been performed for OCSCC. Interestingly, in our cohort, we observed no difference in survival and recurrence outcomes in those with primary and metastatic disease. This may reflect the increased number of patients with stage 3 and 4 disease compared to other literature. Negative prognostic features for survival included comorbidities and T-stage. This study may provide insight into resource planning.