title: Risk factors and survival outcomes for patients with anastomotic leakage after surgery for head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  This study evaluated the risk factors for anastomotic leakage (AL) and survival outcomes in patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Patients with HNSCC who underwent surgery carrying potential AL from 2003 through 2009 were included in this study. Univariate and multivariate analyses were performed and patient survival was calculated by the Kaplan-Meier method.
  
  
  RESULTS
  Of 232 eligible patients, 25 (10.8%) developed AL. Univariate analyses revealed that primary tumor site, salvage surgery, perineural invasion, radiotherapy, chemotherapy, and blood transfusion were significantly associated with the occurrence of AL (P<0.05). Independent risk factors for AL were salvage surgery and blood transfusion (P<0.01). On univariate analysis, AL was significantly associated with overall (OS) and disease-free survivals (DFS; P<0.05) but not with decreased locoregional control (LRC) rate (P=0.07). The 5-year DFS rate was significantly different between the non-leakage and leakage groups (70.9% vs. 27.7%, P<0.001). Multivariate analysis showed, however, that AL was not an independent variable of LRC, DFS, or OS (P>0.1).
  
  
  CONCLUSIONS
  Patients who received salvage surgery and blood transfusion may require careful surveillance for development of AL, which has a tendency toward decreased survival.
authors.affiliation: Department of Otolaryngology, Asan Meidcal Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, Asan Meidcal Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asan Meidcal Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology, Asan Meidcal Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology, Asan Meidcal Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.affiliation: Department of Otolaryngology, Asan Meidcal Center, University of Ulsan College of Medicine, Seoul, Korea. ; Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Korea.
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
keywords: Anastomotic leakage; Head and neck squamous cell carcinoma; Risk factor; Survival