Oral Cancer Surgery and Neck Dissection: A Study of Complications and Prognostic Factors

Abstract

Background: Oral squamous cell carcinoma (OSCC) is a significant global health problem, with surgical resection and neck dissection remaining the cornerstone of curative treatment. Postoperative complications are common and can lead to increased morbidity, treatment delays, and higher healthcare costs. However, the direct impact of these complications on long-term oncologic outcomes is not fully elucidated.

Methods: We conducted a retrospective cohort study of 250 patients who underwent curative-intent surgery for primary OSCC with concomitant neck dissection at a single tertiary academic center between January 2018 and December 2022. Data on patient demographics, tumor characteristics (TNM stage, grade), surgical details (operative time, reconstruction type), and postoperative outcomes were collected. Complications were graded and categorized. Statistical analysis included chi-square tests, t-tests, multivariate logistic regression to identify predictors of complications, and Cox proportional hazards modeling to assess factors influencing DFS.

Results: The mean age of the cohort was 61.4 ± 11.2 years, with a male predominance (68.0%). The overall postoperative complication rate was 35.6% (n=89). The most frequent complications were surgical site infection (15.2%), pharyngocutaneous fistula (8.8%), and partial flap necrosis (6.0%). Multivariate analysis identified advanced T-stage (T3/T4 vs. T1/T2; Odds Ratio [OR] 2.8, 95% CI 1.5-5.2, p=0.002), need for free flap reconstruction (OR 4.1, 95% CI 2.2-7.6, p<0.001), and operative time >8 hours (OR 2.1, 95% CI 1.1-4.0, p=0.02) as independent predictors for developing a major complication. The 3-year DFS was significantly lower in patients who experienced a major postoperative complication compared to those who did not (55.2% vs. 78.9%, p=0.004). In the Cox regression model, positive surgical margins (Hazard Ratio [HR] 3.1, p<0.001), extracapsular nodal extension (HR 2.5, p<0.001), and the occurrence of a major postoperative complication (HR 1.9, p=0.015) were independent negative prognostic factors for DFS.

Conclusion: Postoperative complications following major oral cancer surgery are frequent and are significantly associated with advanced disease and complex reconstructions. Beyond their immediate morbidity, major complications represent an independent negative prognostic factor for disease-free survival. These findings underscore the importance of perioperative optimization and meticulous surgical technique to minimize complications, which may in turn improve oncologic outcomes.