# Identifying High-Risk Patients with Advanced Midface Cancer: Personalized Surgical and Reconstructive Approach for Radical Resection

## TL;DR

This study identifies high-risk patients with advanced midface cancer and proposes personalized surgical and reconstructive approaches to improve outcomes.

## Contribution

The study introduces a clustering approach to identify patient subgroups with distinct prognostic outcomes in midface cancer surgery.

## Key findings

- Cluster B had an 89% recurrence risk, while cluster C had only 6%.
- Larger and complex resective defects correlated with lower disease-free survival.
- Personalized reconstructive surgery is effective for functional and cosmetic outcomes in advanced midface cancer.

## Abstract

The study investigates personalized surgical and reconstructive approaches for advanced midface cancers. Analyzing data from 119 patients treated over a decade identified correlations between clinical factors, resective defect characteristics, and the optimal choice of free flaps for reconstruction. Patients were grouped into four clusters based on risk factors. Cluster B showed the worst prognosis (89% recurrence risk), while cluster C had the most favorable outcomes (6% recurrence risk). The 5-year overall survival rate was 95%, and disease-free survival (DFS) was 77%. Larger and more complex defects (Cordeiro type IIIA and IV) correlated with lower DFS and higher recurrence risk. Our study concludes that reconstructive surgery remains an effective personalized approach for managing advanced midface cancers, highlighting its critical role in achieving functional and cosmetic outcomes.

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 T3 or T4 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 cm2, 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 cm2, 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.