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