Results after resection of extensive carcinomas of the oropharynx and microvascular reconstruction using a radial forearm free flap.

Background: Extensive tumors of the oropharynx require an open approach and plastic reconstruction for good oncologic and functional results. Patients and methods: From January 1988 through December 1996 at the Department of Otolaryngology, Head and Neck Surgery, of the University of Wurzburg, 62 pa tients with extensive tumors of the oropharynx underwent surgical treatment (T2=6, T3=24, T4=32). In 40 patients, the resection was performed via a me dian mandibulotomy approach, in 22 patients using a lateral pharyngotomy. A ll patients underwent postoperative radiotherapy up to 70 Gy. Results: Usin g the Kaplan-Meier method, the five-year survival was 80 % for T2, 52 % for T3, and 22 % for T4. Four patients (7 %) presented with a second primary c arcinoma, and one also had a third carcinoma. Seven patients who died of T3 - and T4-tumors had distant metastases, among them 5 patients who were free of local disease. A regular oral diet was possible on average 14 days post operatively. Ail patients underwent tracheostomy. Ninety percent of them we re decanulated one year postoperatively. Conclusions: Resection of extensiv e carcinomas of the oropharynx and microvascular reconstruction produces go od oncological and functional results. The best access to extensive tumors is provided by a mandibulotomy. The advantage of this excellent approach ou tweighs an increasing morbidity in occasional cases.