Surgical morbidity and mortality in patients after microvascular reconstruction for head and neck cancer

Y-H Joo; K-J Cho; J-O Park; S-Y Kim; M-S Kim

doi:10.1111/coa.13006

Surgical morbidity and mortality in patients after microvascular reconstruction for head and neck cancer

Clin Otolaryngol. 2018 Apr;43(2):502-508. doi: 10.1111/coa.13006. Epub 2017 Nov 15.

Authors

Y-H Joo¹, K-J Cho¹, J-O Park², S-Y Kim¹, M-S Kim¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
² Department of Otolaryngology - Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea.

PMID: 29024491
DOI: 10.1111/coa.13006

Abstract

Objectives: The aim was to evaluate the importance of clinical factors in the prediction of postoperative complications in patients with microvascular reconstruction for head and neck squamous cell cancer (HNSCC).

Design: A retrospective review of case notes was performed.

Setting: Patients treated at a single institute.

Participants: This study included 259 patients with HNSCC treated with radical surgery and microvascular reconstruction between 1993 and 2014.

Main outcome measures: We allocated the patients to three groups using a preoperative comorbidity score based on risk factors: group A (≥3 risk factors, n = 16), group B (2 risk factors, n = 49) and group C (0 or 1 risk factor, n = 194).

Results: Surgical mortality in this cohort was 1.9% (5 of 259 patients). The preoperative comorbidity score was associated with surgical mortality (P < .001). Pharyngocutaneous fistula (P = .001) and flap compromise (P = .023) were more frequent as preoperative comorbidity score increased. Preoperative comorbidity score (P < .001), advanced age (P = .007), advanced pathologic T stage (P = .028), advanced pathologic N stage (P = .005), preoperative (chemo) radiotherapy (P < .001), history of cardiovascular disease (P = .015) and pulmonary disease (P = .007), and diabetes (P < .001) had significant adverse effects on 5 year disease-specific survival (DSS) in a univariate analysis. The 5-DSS rates of groups A, B and C were 30%, 37% and 70%, respectively. Multivariate analysis showed that preoperative comorbidity score was significantly correlated with 5 year DSS (hazard ratio [HR], 3.56; 95% confidence interval [CI], 1.81-6.99; P < .001 for group A and HR, 1.91; 95% CI, 1.15-3.18; P = .013 for group B compared with group C).

Conclusion: Patients with a high preoperative comorbidity score have an increased risk of surgical mortality and morbidity after microvascular reconstruction for HNSCC.

Keywords: head and neck neoplasms; morbidity; mortality; reconstructive surgical procedures; squamous cell carcinoma.

MeSH terms

Adult
Aged
Carcinoma, Squamous Cell / mortality
Carcinoma, Squamous Cell / surgery*
Female
Free Tissue Flaps*
Head and Neck Neoplasms / mortality
Head and Neck Neoplasms / surgery*
Humans
Male
Microsurgery / adverse effects*
Microsurgery / mortality
Middle Aged
Plastic Surgery Procedures / adverse effects*
Plastic Surgery Procedures / mortality
Postoperative Complications / epidemiology*
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult