COMPARATIVE FUNCTIONAL AND ONCOLOGIC OUTCOMES OF VERTICAL RECTUS ABDOMINIS MUSCULOCUTANEOUS VERSUS ANTEROLATERAL THIGH FLAP RECONSTRUCTION AFTER TOTAL OR NEAR-TOTAL GLOSSECTOMY FOR T4 TONGUE SQUAMOUS CELL CARCINOMA.

OBJECTIVE

To compare functional and oncologic outcomes between vertical rectus abdominis musculocutaneous (VRAM) and anterolateral thigh (ALT) flap reconstruction following total or near-total glossectomy in patients with T4 tongue squamous cell carcinoma.

METHODS

This comparative study included 75 patients (Group A: VRAM, n=30; Group B: ALT, n=45) treated between February 2019 and February 2023. Flap selection was based on preoperative pinch test of anterolateral thigh subcutaneous fat thickness (<1.5 cm for VRAM, ≥1.5 cm for ALT). Functional outcomes (speech and swallowing) were assessed at 1 month postoperatively and at 6 months after completion of radiotherapy using validated scales. Disease-free survival (DFS) was analyzed using the Kaplan-Meier method and Cox proportional hazards regression.

RESULTS

Group B demonstrated significantly better speech and swallowing function at 1 month and 6 months postoperatively (p < 0.05). However, in the subgroup analysis of patients with type V (total) glossectomy, functional differences were significant only at 1 month and became comparable by 6 months. The median follow-up was 21.0 months overall and 34.5 months among disease-free patients. The estimated 2-year DFS rates were 50.9% in Group A and 43.0% in Group B (p = 0.557). Multivariate analysis identified lower BMI, positive extranodal extension (ENE), and greater depth of invasion (DOI >20 mm) as independent predictors of worse DFS. Flap type was not an independent prognostic factor.

CONCLUSIONS

Both VRAM and ALT flaps provide comparable long-term functional outcomes when appropriately oversized. Depth of invasion >20 mm was a strong independent adverse prognostic factor in this cohort of T4 tongue squamous cell carcinoma and was associated with significantly worse disease-free survival. This finding is hypothesis-generating and warrants further investigation as a potential refinement to risk stratification within T4 disease.