Prognostic impact of surgical site infections following free-flap reconstruction for head and neck squamous cell carcinoma.

[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 ( = 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;  < 0.001) and RFS (HR, 2.095; 95% CI, 1.135-3.866;  = 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;  < 0.001) and RFS (HR, 2.095; 95% CI, 1.155-4.053;  = 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.