Objective: High incidence of head and neck (H&N) cancer was noted in Eastern Taiwan. H&N cancer patients are often malnourished accompanied with impaired immune function. H&N operation with free tissue transfer reconstruction is found associated with a relatively high incidence of postoperative complications. This study aimed to evaluate the characteristics and outcomes of head and neck cancer patients with free tissue transfer reconstruction via pre-operative nutritional status in Eastern Taiwan.

Material and Methods: We performed a retrospective cohort study of patients with a diagnosis of head and neck cancer who accepted free tissue transfer reconstruction in Hualien Tzu-Chi Hospital between January 2021 and December 2021. Pre-operative nutritional status, demographic profile, operative details and outcomes including post-operative complication rates, total hospitalization day, in-hospital mortality rate and 1-year survival rate were evaluated. Primary outcomes were predictors of higher post-operative complication rate. Secondary outcomes were to evaluate significant factors associated with the individual nutritional status.

Results: Total 98 free flap reconstruction were evaluated. Only 85 free flap containing complete pre-operative nutritional evaluation were included. They were categorized as pre-operative prognostic nutritional index (PNI) ≤ 40, indicating better nutritional status (n=20); or PNI > 40 (n=65), indicating poorer nutritional status. Patients with PNI ≤ 40 had lower rate of dyslipidemia (15% vs 44%, p=0.018), higher Charlson Comorbidity Index (CCI) (5 vs 4, p=0.026); lower pre-operative total cholesterol (TCH), triglyceride(TG), transferrin, pre-albumin, Zinc, Hb; lower post-operative albumin , Hb; higher percentage of hypopharyngeal cancer as primary site (30% vs 6.2%, p=0.01) and longer operation time (min) (632 vs 447, p=0.047). There was no statistical significance over post-operative complications including flap outcome, neck wound outcome, survival outcome, or total hospitalization days. Within multivariant logistic regression analysis, higher level of pre-albumin was associated with lower post-operative complication rate (OR=0.81; 95%CI:0.67-0.91; p=0.022) and longer operation time was associated with higher post-operative complication rate (OR=1.01; 95%CI:1.00-1.02; p=0.021).

Conclusions: Patients with better pre-operative nutritional status which presented as pre-operative prognostic nutritional index (PNI) >40 were associated with higher rate of dyslipidemia, lower Charlson Comorbidity Index (CCI), higher pre-operative nutritional markers including total cholesterol, triglyceride, transferrin, pre-albumin, Zinc, Hb, higher post-operative albumin, Hb; lower percentage of hypopharyngeal cancer as primary sites and shorter operation time. And lower pre-operative pre-albumin and longer operation time were predictors of higher post-operative complication rate.