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. 2022 Jun 24:12:792462.
doi: 10.3389/fonc.2022.792462. eCollection 2022.

Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data

Delong Li  1 , Chong Wang  1 , Wei Wei  2 , Bo Li  1 , Huan Liu  1 , Aoming Cheng  1 , Qifang Niu  1 , Zhengxue Han  1 , Zhien Feng  1
Affiliations

Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data

Delong Li et al. Front Oncol. .

Abstract

Background: Postoperative complications (POCs) of moderate-advanced head and neck squamous cell carcinoma (HNSCC) after free flap reconstruction have received little attention. We investigated the risk factors that lead to POCs and their impact on management and prognosis.

Patients and methods: A single-center, prospective cohort study was conducted at Beijing Stomatological Hospital on primary HNSCC patients treated between 2015 and 2020.

Results: In total, 399 consecutive HNSCC patients who underwent radical resection of the primary tumor and free flap reconstruction were enrolled in this study, 155(38.8%) experienced POCs. The occurrence of POCs directly led to worse short-term outcomes and poorer long-term overall survival (P=0.0056). Weight loss before the operation (P=0.097), Tumor site (P=0.002), stage T4b (P=0.016), an ACE-27 index of 2-3 (P=0.040), operation time≥8h (P=0.001) and Clindamycin as antibiotic prophylaxis (P=0.001) were significantly associated with POCs.

Conclusions: The occurrence of POCs significantly leads to worse short-term outcomes and increases the patients' burden.

Keywords: free flap reconstruction; head and neck cancer; postoperative complications; prediction model; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Multivariable logistic regression analysis was applied to build forest plots.
Figure 2
Figure 2
A Nomogram model is constructed to predict the POCs. (A) The POC risk nomogram was developed by incorporating the following factors: ACE-27 index, weight loss, tumor site, T stage of the tumor, operation time and type of antibiotic prophylaxis; (B) Calibration plots of the nomogram which the y-axis is the actual rate of POCs and the x-axis is the predicted rate of POCs. The diagonal dotted line represents a perfect prediction by an ideal model. The solid line represents the bias-corrected performance of the nomogram, where a closer fit to the diagonal dotted line represents a better prediction; (C) The accuracy of the model for identifying patients with POCs was determined using AUC curve; (D) DCA showed the clinical usefulness of the nomogram. The y-axis measures the net benefit. The red solid line is the nomogram used to predict POC risk. The gray solid line assumes that all patients will develop a POC. The thin black solid line assumes that no patients will develop a POC.
Figure 3
Figure 3
K-M curve drawn by occurrence of POCs and Overall survival (OS) and Disease-Free Survival (DFS) of all patients. (A) K-M curve of POCs and OS; (B) K-M curve of POCs and DFS.
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References

    1. Chow LQM. Head and Neck Cancer. N Engl J Med (2020) 382:60–72. doi: 10.1056/NEJMra1715715 - DOI - PubMed
    1. Cramer JD, Burtness B, Le QT, Ferris RL. The Changing Therapeutic Landscape of Head and Neck Cancer. Nat Rev Clin Oncol (2019) 16:669–83. doi: 10.1038/s41571-019-0227-z - DOI - PubMed
    1. Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, et al. . Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw (2020) 18:873–98. doi: 10.6004/jnccn.2020.0031 - DOI - PubMed
    1. Tolstonog G, Simon C. Trends in Surgical Research in Head and Neck Cancer. Curr Treat Options Oncol (2017) 18:38. doi: 10.1007/s11864-017-0475-z - DOI - PubMed
    1. Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, et al. . Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society. JAMA Otolaryngol Head Neck Surg (2017) 143:292–303. doi: 10.1001/jamaoto.2016.2981 - DOI - PubMed