Joo YH, et al. - This study strived to gauge the significance of clinical factors for speculating the postoperative complications, in patients with microvascular reconstruction for head and neck squamous cell cancer (HNSCC). An elevated risk of surgical mortality and morbidity was discovered in patients with a high preoperative comorbidity score, after microvascular reconstruction for HNSCC.

Methods

• The design of this trial was a retrospective review of case notes.
• It was carried out at a single institute.
• The eligible candidates comprised of 259 patients with HNSCC treated with radical surgery and microvascular reconstruction between 1993 and 2014.
• Herein, patients were allocated 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

• The surgical mortality was discovered to be 1.9% (5 of 259 patients).
• A link was illustrated between the preoperative comorbidity score with surgical mortality (p<0.001).
• Pharyngocutaneous fistula (p=0.001) and flap compromise (p=0.023) appeared to be more frequent alongside the rise in preoperative comorbidity score.
• Preoperative comorbidity score (p<0.001), advanced age (p=0.007), advanced pathologic T stage (p=0.028), advanced pathologic N stage (p=0.005), preoperative (chemo)radiotherapy (p<0.001), history of cardiovascular disease (p=0.015) and pulmonary disease (p=0.007), and diabetes (p<0.001) exhibited prominent 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.
• The preoperative comorbidity score exhibited a prominent connection with 5-year DSS (hazard ratio [HR], 3.56; 95% confidence interval [CI], 1.81-6.99; p<0.001 for group A and HR, 1.91; 95% CI, 1.15-3.18; p=0.013 for group B compared with group C).