Acta oto-laryngologica · 2026
Prognostic impact of surgical site infections following free-flap reconstruction for head and neck squamous cell carcinoma.
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Yonaga Hiroya, Mukaigawa Takashi, Yasunaga Yoshichika, Okada Shinichi, Goto Seiya, Hiiragi Yohei, Morita Shinya
Аннотация
BACKGROUND: Radical surgery with free-flap reconstruction for advanced head and neck squamous cell carcinoma (HNSCC) carries a high risk of postoperative complications.
AIMS/OBJECTIVES: To identify the complication most strongly associated with poor oncologic outcomes.
MATERIALS AND METHODS: We retrospectively evaluated 346 patients who underwent free-flap reconstruction between January 2013 and December 2022. Postoperative complications were classified using Clavien-Dindo (CD) grading. Overall survival (OS), recurrence-free survival (RFS), hospital stay, and the surgery-to-postoperative radiotherapy (S-PORT) interval were evaluated.
RESULTS: Surgical site infection (SSI) was the most common complication (n = 56). Patients with CD grade ≥ IIIa SSI showed significantly worse 5-year OS (hazard ratio [HR], 3.075; 95% confidence interval [CI], 1.605-5.892; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.135-3.866; p = 0.018). Multivariate analysis confirmed CD grade ≥ IIIa SSI as an independent prognostic factor for OS (HR, 3.539; 95% CI, 1.786-7.012; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.155-4.053; p = 0.016). These patients had significantly longer hospital stays, whereas S-PORT intervals showed no difference.
CONCLUSIONS AND SIGNIFICANCE: CD grade ≥ IIIa SSI independently predicts poor survival after free-flap reconstruction in HNSCC. Preventing and promptly managing SSIs are crucial to improving long-term outcomes.
AIMS/OBJECTIVES: To identify the complication most strongly associated with poor oncologic outcomes.
MATERIALS AND METHODS: We retrospectively evaluated 346 patients who underwent free-flap reconstruction between January 2013 and December 2022. Postoperative complications were classified using Clavien-Dindo (CD) grading. Overall survival (OS), recurrence-free survival (RFS), hospital stay, and the surgery-to-postoperative radiotherapy (S-PORT) interval were evaluated.
RESULTS: Surgical site infection (SSI) was the most common complication (n = 56). Patients with CD grade ≥ IIIa SSI showed significantly worse 5-year OS (hazard ratio [HR], 3.075; 95% confidence interval [CI], 1.605-5.892; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.135-3.866; p = 0.018). Multivariate analysis confirmed CD grade ≥ IIIa SSI as an independent prognostic factor for OS (HR, 3.539; 95% CI, 1.786-7.012; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.155-4.053; p = 0.016). These patients had significantly longer hospital stays, whereas S-PORT intervals showed no difference.
CONCLUSIONS AND SIGNIFICANCE: CD grade ≥ IIIa SSI independently predicts poor survival after free-flap reconstruction in HNSCC. Preventing and promptly managing SSIs are crucial to improving long-term outcomes.