Identifying High-Risk Patients with Advanced Midface Cancer: Personalized Surgical and Reconstructive Approach for...

Individually personalized reconstructive microsurgery is more and more universally recognized and applied as a one-time, part of a few, or even the only highly effective treatment of patients with locally advanced midface cancer. Among the increasing number of publications focused on this field, most present different reconstructive techniques used for a single patient (case reports), and fewer papers evaluate a group including more than 100 patients.

A dataset of 119 locally advanced midface cancers in stage T₃ or T₄ was used to analyze whether there is any correlation between clinical factors, resection defect parameters, and the free flaps chosen for reconstruction.

In general, the 5-year OS was 95% and 77% for the DFS, which inversely correlated with the increasing Cordeiro's type of resective defects. Local recurrence occurred in 23% of cases. Taxonomic dendrograms allow the selection of four (A-D) different case clusters. Cluster B, which characterizes a tumor size of 8-18 cm², Cordeiro type IIIA, and an uncertain radicalism of resection, has the worst prognosis with a very high (89%) risk of local recurrence. On the contrary, the most favorable was found in cluster C, characterized by Cordeiro type IIA, a tumor size of 8 cm², and negative resective margins, because it has a very low (6%) risk of local recurrence.

The results of the present analysis have led to design algorithms for midface resection and reconstruction. However, these should not be considered obligatory but rather as a useful general guideline.