BACKGROUND & OBJECTIVES
Fibrin sealants are commonly used in hemostasis and tissue adhesion in surgical procedures. However, the results in previous randomized-control trials varies. This study aimed to analyze the surgical outcome and survival status of oral cancer patients who had undergone primary cancer site removal and applied fibrin sealant after free flap reconstruction.

MATERIAL & METHODS
Data of this retrospective study were extracted from the Kaohsiung Medical University Hospital Research Database (KMUHRD). All patients with newly diagnosed oral cancer and received primary tumor resection during January 1st, 2009 to December 31st, 2019 were included initially. Those who did not undergo free flap reconstruction, had been treated in other medical institutions, or were under 18 years old were excluded. The exposed group was defined as patients with the use of fibrin sealants in combination with drainage after the free flap reconstructive surgery. The non-exposed (control) group was managed with post-operative drainage alone.
We compared the target study group and control group. The baseline demographics of these two groups were described in terms of sex, age, education level, site of tumor, grading, pathologic stage, social behaviors (alcohol drinking, betel nut chewing, cigarette smoking), the requirement of re-DO (debridement, vascular exploration, secondary free flap surgery), recurrence of cancer, and survival status. The primary outcome of this study was the requirement of re-DO, and the secondary outcomes were survival status and cancer recurrence rates.


RESULTS
Among the 632 participants, the 351 individuals in the exposed group and 281 individuals in the non-exposed (control) group were matched based on their sex, age, education level, site of tumor, pathologic stage, and social behaviors. The differences in their survival status (p = 0.0010) and re-DO rates (p = 0.0047) were statistically significant. However, there was no difference in cancer recurrence rates (p = 0.5158).

DISCUSSION
Fibrin sealants blocks damaged lymphatic ducts, promotes tissue adhesion, and prevents seroma by forming fibrin and reducing shear forces in surgical wounds. Currently, fibrin sealants are widely reported in studies of seroma prevention in breast cancer-related radical mastectomy with axillary lymph node dissection and latissimus dorsi donor-site. However, their consequences in seroma prevention were contradictory.
In this study, reduction in re-DO rates may be explained by fibrin sealant’s characteristic of promoting tissue adherence and reducing shear forces to reduce complications. Though we still need additional information to demonstrate the relationship between application of fibrin sealants and survival status of oral cancer patients post-operatively.

CONCLUSION
Real world evidence of fibrin sealant usage after free flap reconstruction in oral cancer patients points out that applying fibrin sealant contributes to reducing re-DO rates, and has significant correlation with post-operative survival status. Yet, the latter conclusion requires further discussion and investigation.

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