Abstract
BACKGROUND: 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. METHODS: A dataset of 119 locally advanced midface cancers in stage T(3) or T(4) was used to analyze whether there is any correlation between clinical factors, resection defect parameters, and the free flaps chosen for reconstruction. RESULTS: 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 cm(2), 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 cm(2), and negative resective margins, because it has a very low (6%) risk of local recurrence. CONCLUSIONS: 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.