(0736) The Association of Neoadjuvant Therapy and Postoperative Complications With Head and Neck Cancer Surgery

Introduction: Neoadjuvant therapy is increasingly being utilized in the treatment of head and neck squamous cell carcinoma (HNSCC), although the impact on postoperative complications is unknown. Microvascular free tissue transfer (MFTT) is a reliable reconstruction method; however, complications can be common. Our study aimed to determine if induction therapy is associated with complications.

Methods: A retrospective review of a prospective database was conducted of all patients with HNSCC and no prior treatment who underwent surgery with MFTT between 2019-2023. A postoperative complication was defined as any surgical site infection, vascular compromise, salivary leak, thrombotic/embolic event, or cardiovascular event. Multivariable logistic regression was used to assess factors associated with complications and the impact of neoadjuvant therapy.

Results: A total of 281 patients were included in the study, of which 28 (10.0%) underwent neoadjuvant therapy, including 25 (8.9%) immunotherapy and 5 (1.8%) chemotherapy with three months of surgery. Complications occurred in 124 (44%) patients. After adjusting for age, gender, reconstruction type, diabetes, tobacco use, and alcohol abuse, patients who underwent neoadjuvant therapy tended to be twice as likely to have a surgical complication (odds ratio [OR] 2.05, 95% confidence interval [CI] 0.88-4.78, P = .096), compared to patients who did not receive neoadjuvant therapy. Age (OR 1.03, P = .011), bony tissue transfer (OR 1.69, P = .053), and multiple flaps (OR 1.81, P = .025) were independently associated with complications.

Conclusions: Neoadjuvant therapy may be associated with greater postoperative complications in patients with HNSCC undergoing MFTT. The risks of induction immunotherapy and chemotherapy should be further explored.