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

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

Author information

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.

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

PMID:
29024491
DOI:
10.1111/coa.13006
[Indexed for MEDLINE]

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