Surgical morbidity and mortality in patients after
microvascular reconstruction for head and neck cancer
Department of Otolaryngology-Head and
Neck Surgery, College of Medicine, The
Catholic University of Korea, Seoul, Korea
Department of Otolaryngology - Head and
Neck Surgery, Inje University College of
Medicine, Haeundae Paik Hospital, Busan,
M-S. Kim, Department of Otolaryngology-
HNS, Mary’s Hospital, The Catholic
University of Korea, Seoul, Korea.
Objectives: The aim was to evaluate the importance of clinical factors in the predic-
tion 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 sur-
gery and microvascular reconstruction between 1993 and 2014.
Main outcome measures: We allocated the patients to three groups using a preop-
erative 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 preoper-
ative comorbidity score was associated with surgical mortality (P < .001). Pharyngo-
cutaneous 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 preoper-
ative 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
The importance of surgical excision of head and neck squamous cell
carcinoma (HNSCC) with respect to disease control, survival duration
and quality of life is well established. Accordingly, surgery remains
the primary therapeutic intervention for most patients with HNSCC.
Recent advances in anaesthetic and surgical techniques, including
microvascular reconstruction, have allowed the use of more radical
oncologic procedures for advanced head and neck cancer. However,
the curative intent of surgery can be limited by the hazard of life-
threatening perioperative complications.
Accurate prediction of surgical morbidity and mortality is impor-
tant not only for appropriate selection of candidates for surgery, but
also for evaluation of quality of care and policy decisions. The most
common risk factors that predispose patients to the development of
HNSCC will collaterally and concurrently select for a population of
patients of advanced age, often with significant chronic comorbidi-
ties such as cardiovascular and pulmonary disease along with
Accepted: 28 September 2017
© 2017 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/coa Clinical Otolaryngology. 2018;43:502–508.