Plastic surgeon or surgical oncologist: Impact of surgical training background on outcomes in microsurgical head and neck reconstruction.

BACKGROUND

Microvascular free flap reconstruction is central to contemporary head and neck cancer surgery. Although plastic surgeons have traditionally performed these reconstructions, evolving training pathways have enabled other surgical subspecialties to acquire advanced microsurgical expertise. Comparative data between plastic surgeons and surgical oncologists trained in microsurgical reconstruction remain limited.

METHODS

We performed a retrospective cohort study of 300 patients who underwent head and neck reconstruction at the Cancer Institute of Iran between 2013 and 2022. Patients were stratified by operating surgeon specialty (surgical oncologist vs. plastic surgeon). Primary outcomes included operative duration, postoperative hemorrhage, flap failure, intensive care unit (ICU) stay, and mortality. Cumulative sum (CUSUM) analysis was used to assess performance trends and learning curves over time.

RESULTS

Of 300 reconstructions, 192 (64.0%) were performed by surgical oncologists and 108 (36.0%) by plastic surgeons. Baseline demographics and comorbidities were comparable between groups. There were no significant differences in flap failure (9.4% vs. 9.3%), postoperative hemorrhage (7.3% vs. 3.7%), ICU stay, or mortality (4.2% vs. 3.7%). Operative duration was longer in the surgical oncology group on unadjusted analysis; however, surgeon specialty was not an independent predictor after multivariable adjustment. CUSUM analysis demonstrated stable outcomes over time for both groups, with no evidence of an active learning curve.

CONCLUSION

In a high-volume center with structured microsurgical training, surgical oncologists achieve outcomes comparable to plastic surgeons in head and neck reconstruction. These findings support expansion of microsurgical reconstruction beyond traditional specialty boundaries when appropriate training and institutional support are present.