Comparison of T1/2 Tongue Carcinoma with or without Radial Forearm Flap Reconstruction Regarding Post-Therapeutic Function, Survival, and Gender

SIMPLE SUMMARY: Surgical therapy for tongue carcinoma is challenging due to the various important functions of the tongue. In order to compensate for loss of tongue tissue and function, flap reconstruction has been firmly established. Interestingly, a large number of early-stage tongue cancer receive flap reconstruction despite minor tissue loss. This study aims to investigate functional and survival differences as well as epidemiologic characteristics in tongue carcinoma patients with or without flap reconstruction. Our retrospective and prospective analyses show no significant survival or functional differences between the groups with or without flap reconstruction. Still, we were able to demonstrate that the possibility of flap reconstruction leads to a more generous tumor resection, less frequent presence of close margin, and subsequently less frequent use of toxic adjuvant therapy regimens. Moreover, for the first time, a significantly higher female ratio could be depicted in the reconstruction group (p = 0.02). These findings suggest that, apart from oncologic and functional factors, proportional aspects should be taken into consideration for future decisions on the optimal reconstruction method. ABSTRACT: Background: Flap reconstruction is commonly used in advanced tongue carcinoma in order to compensate for the loss of tongue tissue and function. Surprisingly, a large number of reconstructed early-stage tongue cancer can be found. Survival or functional benefits in these cases remain unclear. Methods: A retrospective data analysis of 384 surgically treated tongue carcinoma patients was conducted aiming to find epidemiologic and survival differences between patients with (n = 158) or without flap reconstruction (n = 226). A prospective functional analysis was performed on 55 early-stage tongue cancer patients, 33 without and 22 with radial-forearm flap reconstruction, focusing on post-therapeutic swallowing function as the primary endpoint, speech as the secondary endpoint, xerostomia, quality of life, and mouth opening. Results: Consistent with the current literature, we demonstrated the significantly more frequent use of flap grafts in advanced tongue carcinomas. For the first time, we depicted a higher female ratio in the reconstructed group (p = 0.02). There were no significant differences in survival or functional outcomes between the groups. The none-reconstructed group showed more frequent use of adjuvant C/RT despite presenting fewer N+ stages. Conclusions: The higher female ratio in the reconstruction group is plausible due to the anatomically smaller oral cavity and relatively larger carcinoma in women. A higher presence of close margins in the none-reconstruction group may explain the more frequent use of adjuvant C/RT. Since we found no survival or functional differences between the groups, we propose a critical approach toward flap reconstruction in T1/2 tongue carcinoma. At the same time, proportional aspects and adequate resection margins should be taken into account.