Outcomes Following Surgical Management of Advanced Oral Cavity Cancers in Patients with Scleroderma: A Case Series

To evaluate the surgical outcomes and perioperative complications in patients with systemic sclerosis (SSc) undergoing surgical resection with free flap reconstruction for advanced oral cavity squamous cell carcinoma (OCSCC).

Retrospective review of SSc patients who underwent surgical resection with free flap reconstruction for oral cavity SCC from 2008 to 2023. Data extracted included demographics, SSc subtype, cancer characteristics, surgical details, postoperative complications, and long-term outcomes.

Four female patients over age 50 were identified; 2 had diffuse SSc and 2 had limited SSc. All presented with pathologic stage IV OCSCC. Free flap reconstruction included scapular (n = 2), radial forearm (n = 1), and fibular (n = 1) flaps. No patients experienced flap failure. All patients experienced at least 1 postoperative complication. Major morbidity, defined as prolonged ICU admission (>7 days), prolonged tracheostomy dependence (>30 days), cardiopulmonary arrest, or death within 1 year, occurred exclusively in patients with diffuse SSc (50%). Both diffuse SSc patients required hospitalization exceeding 35 days and died within 1 year of surgery. Patients with limited SSc had shorter stays and more favorable outcomes.

Microvascular free flap reconstruction is feasible in SSc patients with OCSCC; however, those with diffuse SSc may experience higher morbidity and mortality. SSc subtype should be considered in preoperative planning. Further multicenter studies are needed to guide management in this high-risk population.