Does Neoadjuvant Chemotherapy Increase Reconstructive Risk? A Comparative Analysis of Surgical Efficiency and Microvascular Success in Advanced
OSCC
Esmat Najjar, Morad Abdelraziq, Dan Yaniv, Amii Ritter, Imad Abu‐Elnaaj, Yasmin Ghantous ABSTRACT
Objective
To investigate the effect of neoadjuvant chemotherapy (NACT) by evaluating its impact on surgical efficiency and postoperative morbidity in patients undergoing complex free‐flap reconstruction for advanced oral cavity squamous cell carcinoma (OSCC).
Methods
A retrospective comparative study was conducted on 86 patients (NACT cohort: n = 20; Primary Surgery cohort: n = 66) undergoing microvascular free tissue transfer. Primary outcomes included surgical efficiency (ischemic time, total operative duration) and postoperative complications (major microvascular events vs. minor wound issues) that were evaluated.
Results
The NACT group presented with significantly more advanced disease (100% Stage IV vs. 39.4%; p < 0.001). Despite this higher tumor burden, the NACT cohort demonstrated significantly shorter mean ischemic times (39.0 ± 7.5 vs. 52.5 ± 17.9 min; p = 0.001) and reduced operative durations (7.5 ± 0.8 vs. 8.6 ± 1.3 h; p = 0.001). Total complication rates were comparable (35% vs. 33.3%). However, minor wound‐related complications were significantly more frequent in the NACT group (30% vs. 4.5%; p = 0.004). The flap salvage rate following re‐exploration was high and comparable between groups (80.0% vs. 85.7%).
Conclusion
No statistically significant differences were detected in major flap failure or vascular re‐exploration, though the study was underpowered to establish definitive safety equivalence for these endpoints. In exploratory subgroup analysis of RFFF reconstructions, NACT was associated with reduced ischemic time ( p = 0.017). These findings suggest that while NACT compromises soft‐tissue wound healing, it does not preclude successful microvascular reconstruction when managed with appropriate perioperative care.