Second primary carcinoma arising on a flap: a new primary or a relapse?

Gerardo Petruzzi; Teodosio de Bonis; Valentina Manciocco; Barbara Pichi; Valentina Rosati; Oreste Iocca; Luca Sedran; Silvia Moretto; Flaminia Campo; Armando De Virgilio; Giuseppe Spriano; Raul  Pellini

doi:10.23750/abm.v94i4.14674

Second primary carcinoma arising on a flap: a new primary or a relapse?

Authors

Gerardo Petruzzi Gerardo Petruzzi: Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Teodosio de Bonis Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Valentina Manciocco Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Barbara Pichi Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Valentina Rosati Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Oreste Iocca Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Torino, Torino, Italy
Luca Sedran Division of Maxillofacial Surgery, Città della Salute e della Scienza, University of Torino, Torino, Italy
Silvia Moretto IRCCS Regina Elena National Cancer Institute
Flaminia Campo Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Armando De Virgilio Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy.
Giuseppe Spriano Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy - Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
Raul Pellini Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

DOI: https://doi.org/10.23750/abm.v94i4.14674

Keywords:

Free flap, reconstructive surgery, second primary, squamous cell carcinoma, mucosalization, relapse

Abstract

Background and aim: Free flaps or pedicle flaps are the mainstay of cancer surgery in the head and neck area. However, their long-term sequelae are still poorly understood. Among these, the development of a secondary primary tumor on a flap is a rare and uncertain reported event.

Methods: A computer-aided systematic literature search was performed by using the PubMed, EMBASE and Cochrane Library databases. A systematic review of the literature, following the PRISMA checklist, was carried out with the aim of analyzing all the citations reporting this second primary, with attention to risk factors, behavior, etiological causes.

Results: Overall, 27 cases of second primary squamous cell carcinoma arising on a pedicle or free flap were identified. In addition, other three cases were discussed.

Conclusions: Persistent exposure to oral stimuli such saliva, oral microbiome, smoke or a colonization by the adjacent mucosa were considered as a possible cause of second primary carcinoma. Although rare, a new neoplasm onset should know and considered as a new concept in the follow-up of patients undergoing reconstruction with free or pedicle flaps.

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