Postoperative infection predicts poor survival in locoregionally advanced oral cancer

Abstract

Background We ascertain the association of postoperative infection on survival in patients with locoregionally advanced oral cavity squamous cell carcinoma (OCSCC). Methods A retrospective study of patients with stage III/IVA OCSCC undergoing curative‐intent surgery was performed. Postoperative infection was considered within 30 days after surgery. Kaplan‐Meier survival curves were used to compare overall survival (OS) in patients with postoperative infection. Cox regression and propensity‐score matching were used to adjust for confounders. Results Fifty‐four of 114 patients had a postoperative infection. The 5‐year OS in patients with a postoperative infection (24.1%) was lower than those without (65.2%; P < .0001). Postoperative infection was a negative predictor of OS after adjusting for patient, antibiotic, pathologic, and operative factors; the adjusted hazard ratio for OS was 2.54 (95% confidence interval, 1.27‐5.09). Conclusion Postoperative infection is a strong negative predictor of OS in patients with OCSCC undergoing ablative surgery.

Predictors of surgical site infection and pneumonia following oral cavity tumor surgery

“…This is likely due to the exclusion of mandibulectomy as a possible separate and unique variable and instead usage of only subsites, such as buccal mucosa, alveolus, and tongue in the analysis. 2,5 In contrast, the current report has utilized mandibulectomy as a separate factor and confirmed it as the most important and only independent risk factor for SSI. Intragroup analysis has revealed both marginal and segmental mandibulectomy to retain individual and independent value as risk factors.…”

“…Most prior studies on SSI have failed to identify mandibulectomy as a risk factor. This is likely due to the exclusion of mandibulectomy as a possible separate and unique variable and instead usage of only subsites, such as buccal mucosa, alveolus, and tongue in the analysis 2,5 . In contrast, the current report has utilized mandibulectomy as a separate factor and confirmed it as the most important and only independent risk factor for SSI.…”

“…Many studies have failed to include TUA as a risk factor 2,7 or only examined long duration free flaps without including shorter duration cases, 7,10 thus possibly failing to highlight the importance of TUA. However, Xu et al in a study that is comparable to the current one with regard to sample size and patient characteristics found results similar to the present report, that is, prolonged TUA independently elevated pneumonia risk in oral cavity surgery 21 .…”

“…Causes of SSI and pneumonia are poorly understood and have not been well studied. Prior reports are limited by small sample size, 2,3,5 lack of proper definition of SSI, 5,6 and highly variable antibiotic regimes within the study population 6,7 . Many have concentrated on only one variable, that is, perioperative antibiotic prophylaxis, but still document SSI rates of approximately 21% in the “intervention” or “better” antibiotic arm 8,9 .…”

“…Oral cavity tumor surgery remains one of the most morbid interventions due to its capacity to alter the anatomy and physiology of cosmesis, speech, mastication, and swallowing. Despite many advances over the years in microbial sterilization, patient preparation, antibiotic therapy, and surgical techniques and tools designed to minimize tissue trauma postoperative surgical site infection (SSI) and pneumonia continue to occur in approximately 8%-50% 1,2 and 11%-35% [2][3][4] of cases, respectively. They increase duration of hospital stay, consume precious resources, delay initiation of oral diet, potentially delay adjuvant radiotherapy and diminish locoregional control, 2 and rarely cause death.…”