Impact of preoperative comorbidities on postoperative complication rates and survival outcome in patients with head and neck cancer undergoing surgical treatment

This retrospective study investigated the impact of preoperative comorbidities on postoperative complications and survival in 408 head and neck cancer (HNC) patients undergoing complete tumor resection for curative intent. The mean age was 62.5 ± 13.2 years; 58.6% were male, 32.4% had pT3-4 tumors, and 27.5% had pN1-3 disease. Comorbidities were present in 70.6%, primarily hypertension (36.8%), cardiac disease (24.5%), endocrine/metabolic diseases (21.6%), pulmonary diseases (13.2%), and cerebrovascular diseases (CVDs, 10.8%). The overall postoperative medical/surgical complications rate was 24.7% (medical: 8.1%, surgical: 18.4%). Patients with comorbidities had higher complication rates (28.1% overall, 9.4% medical, 20.5% surgical). CVDs (20.5% vs. 6.6%), cardiac disease (14.0% vs. 6.2%), and endocrine/metabolic diseases (13.6% vs. 6.6%) significantly increased medical complication risks. Multivariable analysis identified tumor located in oral cavity, ASA grade III-IV, prolonged operation (> 3 h), flap reconstruction, and tracheotomy as independent risk factors for complications. Survival analysis showed reduced overall survival in patients with higher ASA grades, cervical lymph node metastasis, or history of preoperative adjuvant therapy (radiotherapy, chemotherapy, concurrent chemoradiotherapy). The findings highlight that preoperative CVDs, cardiac disease, or endocrine/metabolic disorders elevate medical complication risks by 2-3 times, underscoring the need for thorough preoperative assessment to improve outcomes in HNC surgery.