Review of published literature investigating the relationship of SSI on HNC survival outcomes.
| Author, year | n | % of free flaps in cohort | Primary site | Complication | Findings | Study design | Level of evidence | Use of a standardized SSI definition |
|---|---|---|---|---|---|---|---|---|
| Schantz et al. 1980 [49] | 201 | Not reported | Larynx | SSI | Improved 5-year OS (44% vs 31%, P-value not reported). | Retrospective | III | No |
| Jackson and Rice 1990 [50] | 100 | Not reported | All HNC sites | SSI | No association with RFS (43% vs 64%, P = 0.20). | Retrospective | III | No |
| Grandis et al. 1992 [51] | 134 | Not reported | All HNC sites | SSI | Worse DFS (40% vs. 55%, P = 0.04) | Retrospective | III | No |
| Rodrigo and Suárez 1998 [52] | 158 | Not reported | Larynx | SSI | Increased recurrence (57% vs 27%, P = 0.04); no association with 3-year OS (57% vs. 73%, P = 0.20). | Retrospective | III | No |
| Penel et al. 2004 [53] | 95 | 33 (34.7%) | HNC violating the aerodigestive tract | SSI | No association with local recurrence (25.5% vs. 22.9%, P = 0.8) or death (53.2% vs. 56.3%, P = 0.39) | Prospective | II | No |
| González-Márquez et al. 2012 [54] | 129 | Not reported | Larynx and hypopharynx | SSI | Worse 3-year DSS (HR 1.9, 95% CI 1.01–3.60, P = 0.04). | Retrospective | III | No |
| Hirakawa et al. 2013 [55] | 277 | 154 (55.6%) | All HNC sites | SSI | No association with 5-year OS (46.7% vs 54.2% SSI, P = 0.57) | Retrospective | III | No |
| Mascarella et al. 2019 [56] | 114 | Not reported | Oral cavity | Postoperative infection, including systemic | Worse 5-year OS (24.1% vs. 65.2%, P < 0.0001) | Retrospective | III | No |
| de Almeida et al. 2019 [57] | 551 | Not reported | Oral cavity | SSI | No association with 5-year RFS (51% vs. 62%, P = 0.21) or OS (63% vs. 67%, P = 0.71) | Retrospective | III | No |
| Davies et al. 2021 [58] | 550 | 135 (24.5%) | Larynx (salvage laryngectomy) | Pharyngocutaneous fistula | Associated with distant metastases (HR 2, 95% CI 1.22–3.27, P = 0.005). | Multicenter retrospective | III | No |
| Hiraoka et al. 2022 [59] | 67 | 67 (100%) | Oral cavity | SSI | Worse OS (HR 2.69, 95% CI 1.038–6.970, P = 0.04) | Retrospective | III | No |
| Thiagarajan et al. 2023 [60] | 245 | 83 (33.8%) | All HNC sites | SSI | Worse DFS (OR 3.75, 95% CI 1.799–7.849, P < 0.001) | Retrospective | III | No |
| Yonaga et al. 2026 [61] | 346 | 346 (100%) | All HNC sites | Clavien-Dindo grade ≥ IIIa SSI | Worse OS (HR 3.53, CI 95% 1.8-7.01, P < 0.001) and RFS (HR 2.1, 95% CI 1.2–4.1, P < 0.001) | Retrospective | III | Clavien-Dindo |
DFS: disease-free survival; HNC: head and neck cancer; RFS: recurrence-free survival; SSI: surgical site infection; OR: odds ratio; OS: overall survival.
MKH: Conceptualization, Writing—original draft, Writing—review & editing. JK, WLC, VH: Writing—original draft, Writing—review & editing. JDS: Writing—review & editing, Supervision. MES: Conceptualization, Writing—review & editing, Supervision. All authors read and approved the submitted version.
The authors declare that they have no conflicts of interest.
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