Elsevier

Oral Oncology

Volume 97, October 2019, Pages 23-30
Oral Oncology

Postoperative wound infections, neutrophil-to-lymphocyte ratio, and cancer recurrence in patients with oral cavity cancer undergoing surgical resection

https://doi.org/10.1016/j.oraloncology.2019.07.023Get rights and content

Highlights

  • •

    Infection was not related to poorer outcomes, but did trend with distant metastasis.

  • •

    Tumour factors, including T and N category were associated with wound infection.

  • •

    Neutrophil-to-lymphocyte ratio was not associated with survival or cancer recurrence.

Abstract

Background

It is unclear whether postoperative wound infections after head and neck cancer surgery are associated with cancer progression.

Methods

Patients undergoing surgery for oral cancer from 1998 to 2011 were reviewed. Univariable analyses and multivariable were performed. Propensity scores were used to create matched cohorts for infection and non-infection groups. Neutrophil-to-lymphocyte ratios (NLR) were determined prior to surgery and at the time of infection.

Results

Of 551 patients with oral cancer treated with surgery, 98 developed wound infections (18%). Tumor factors associated with wound infections included higher T and N category, extranodal extension, depth of invasion, lymphovascular and perineural invasion (p < 0.02 for all). On univariable analysis, wound infection was a predictor for recurrence free survival (p < 0.001), locoregional control (p = 0.01), and distant control (p < 0.001). Wound infection was not a predictor of overall survival (p = 0.88), recurrence free survival (p = 0.17), locoregional control (p = 0.79) or distant control (p = 0.18) on multivariable analysis. Using a propensity score matched cohort of 83 patients with and without infection, wound infection was not associated with recurrence free survival (p = 0.21), overall survival (p = 0.71), and locoregional control (p = 0.84), although there was a trend towards increased distant metastases (p = 0.10). Patients with wound infection had a greater preoperative NLR as well as a greater rise in the NLR after surgery, but these were not associated with survival or recurrence.

Conclusions

Patients with wound infections have more adverse pathologic features. However, wound infection was not associated with poorer cancer outcomes although a trend towards increased distant metastases should be investigated.

Section snippets

Background

The relationship between postoperative wound infection following oncologic surgery and cancer outcomes is inconclusive. Some studies have shown an association between wound infection with cancer recurrence in several types of cancer, although the nature of this association and exact mechanism remain unclear [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. In contrast, some preliminary studies suggest a protective effect of postoperative infections on both cancer recurrence and survival

Methods

The Institutional Research Ethics Board at the University Health Network granted approval for the study. Consecutive patients from 1998 to 2011 with oral cavity squamous cell carcinoma treated at the University Health Network (Toronto General Hospital/Princess Margaret Cancer Center) were identified through the Ontario Cancer Registry. Records were retrospectively reviewed and were cross-referenced with a contemporaneous prospectively collected radiation oncology database (2001–2011) [24]. All

Results

A total of 551 patients with oral cavity cancer who were treated with surgical resection and neck dissection in our institution were identified. Postoperative infections developed in 98 (18%) patients. Types of infections included superficial incisional infection in 5 patients (0.9%), deep incisional infection including wound dehiscences in 22 patients (4%), organ-space infection including neck abscess in 35 patients (6.4%), and fistula in 36 patients (6.5%). Of all infections, 57 patients

Discussion

Despite some early compelling evidence to suggest that postoperative wound infections may be a risk factor for recurrence in head and neck cancer [1], [2], [4], controversy still exists with conflicting results suggesting the contrary [3]. In the present study, we demonstrated that patients who develop wound infections after surgical resection of oral cavity cancers have a propensity for more advanced cancers with adverse pathologic features. After adjusting for differences in clinical

Conclusions

Patients with postoperative wound infection after oral cavity cancer surgery are at risk for poorer outcomes. However, this risk of poor outcomes may be attributed to more advanced tumors and nodal disease as well as adverse pathologic features. After accounting for these confounding factors, patients with wound infections do not have a higher risk of poor outcome.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

The authors have no conflicting interests or relevant financial disclosures.

References (49)

  • E.M. Bekes et al.

    Tumor-recruited neutrophils and neutrophil TIMP free MMP-9 regulate coordinately the levels of tumor angiogenesis and efficiency of malignant cell intravasation

    Am J Pathol

    (2011)
  • M. Belusic-Gobic et al.

    Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery

    J Craniomaxillofac Surg

    (2018)
  • J.R. Grandis et al.

    Postoperative wound infection. A poor prognostic sign for patients with head and neck cancer

    Cancer

    (1992)
  • R.M. Jackson et al.

    Wound infections and recurrence in head and neck cancer

    Otolaryngol Head Neck Surg

    (1990)
  • H.H. Ramadan et al.

    Effect of wound infections on head and neck cancer

    Arch Otolaryngol Head Neck Surg

    (1992)
  • A. Mirnezami et al.

    Increased local recurrence and reduced survival from colorectal cancer following anastamotic leak: systematic review and meta-analysis

    Ann Surg

    (2011)
  • N.K. Behnke et al.

    Does postoperative infection after soft tissue sarcoma resection affect oncologic outcomes?

    J Surg Oncol

    (2014)
  • E.M. Sturgis et al.

    Perioperative transfusion, postoperative infection and recurrence of head and neck cancer

    South Med J

    (1997)
  • D.M. Sensenig et al.

    Results of the surgical treatment of bronchogenic carcinoma

    Surg Gynecol Obstet

    (1963)
  • F.P. Herter et al.

    Preoperative intestinal preparation in relation to subsequent development of cancer at the suture line

    Surg Gynecol Obstet

    (1968)
  • D.N. Papachristou et al.

    Effect of postoperative wound infection on the course of stage II melanoma

    Cancer Res

    (1979)
  • B. McDonald et al.

    Systemic inflammation increases cell adhesion to hepatic sinusoids by neutrophil mediated mechanisms

    Int J Cancer

    (2009)
  • J.D. Spicer

    neutrophils promote liver metastasis via Mac-1 mediated interactions with circulating tumor cells

    Cancer Res

    (2012)
  • S.H. Huang et al.

    Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes in oropharyngeal cancer stratified by human papillomavirus status

    Cancer

    (2015)

    • Cited by (13)

    View all citing articles on Scopus
    View full text
    © 2019 Published by Elsevier Ltd.