title: Relationship between postoperative complications and survival after free flap reconstruction for oral cavity squamous cell carcinoma.
abstract: BACKGROUND
  Current literature on the effect of postoperative complications on survival outcomes in head and neck cancers remains contradictory. This study assesses whether postoperative complications adversely affect survival in cases of complex surgical ablation and reconstruction of oral squamous cell carcinoma.
  
  
  METHODS
  In all, 255 consecutive patients with complete clinicopathologic data were included. Survival was determined using the log-rank test and Kaplan-Meier survival curves were generated. A Cox proportional hazards model was used to adjust for the effect of other significant covariates to determine the independent effect of complication variables for overall survival (OS). A competing risk model was used for disease-specific survival (DSS).
  
  
  RESULTS
  On multivariable analysis, major complications independently prognosticated for reduced OS [hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.1-3.2, p = .02]. There was no evidence for an association between any complication-variable and DSS or recurrence.
  
  
  CONCLUSIONS
  Major postoperative complications are independently associated with decreased OS.
authors.affiliation: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Sydney
authors.initials: S
authors.lastname: Ch'ng
authors.forename: Vincent
authors.initials: V
authors.lastname: Choi
authors.forename: Michael
authors.initials: M
authors.lastname: Elliott
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: oral squamous cell carcinoma; postoperative complications; survival