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

Abstract

BackgroundPostoperative 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 MethodsA single-center, prospective cohort study was conducted at Beijing Stomatological Hospital on primary HNSCC patients treated between 2015 and 2020.ResultsIn 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.ConclusionsThe occurrence of POCs significantly leads to worse short-term outcomes and increases the patients’ burden.

Exosomes Derived from Bone Marrow Mesenchymal Stem Cells Alleviate Ischemia-Reperfusion Injury and Promote Survival of Skin Flaps in Rats

“…Flap transplantation is an essential tissue or organ reconstruction method for cancer surgery or trauma [ 2 ]. However, partial necrosis of flaps caused by IR injury remains a common clinical problem that may lead to disastrous consequences, such as secondary surgery and increased financial burden on patients [ 28 ]. Thus, there is a need to find an effective way to improve the success rates of flap transplantation.…”

Bone Marrow Mesenchymal Stem Cells-Derived Exosomes Promote Survival of Random Flaps in Rats through NRF2-Mediated Antioxidative Stress

“…Random flaps are widely used to repair head and neck tissue defects caused by trauma and tumor resection because of their convenient and flexible characteristics 1 . However, because a random flap has no well-known blood vessels, OS, apoptosis, inflammation, and other pathological processes often occur in the local microenvironment of the distal region owing to ischemia, resulting in flap necrosis.…”

Incidence and risk factors for postoperative delirium after head and neck cancer surgery: an updated meta-analysis

“…Over the past few decades, researchers have made great efforts to explore therapeutic strategies for head and neck cancer, such as radiotherapy, chemotherapy, and immunotherapy; however, surgical resection is still the main treatment method [ 3 ]. Unfortunately, owing to the complex nature, multiple comorbidities, highly invasive and extensive surgical procedures, and longer operation time, surgery may inevitably lead to postoperative complications, which not only prolong the hospital stay and decrease the quality of life but also increase the total hospital cost and the risk of mortality [ 4 ]. Postoperative delirium (POD), a relatively frequent neuropsychiatric disorder after anesthesia and surgery, is an acute and transient cerebral disorder characterized by disturbance of attention, perception, and consciousness [ 5 ].…”