Hsieh Yu-Hsuan, Kao Chia-Chen, Lin Cheng-Ta, Liu Wen-Chung, Yang Kuo-Chung, Ho Yen-Yi, Tsai Wei-Hsuan, Chen Lee-Wei
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
National Yang-Ming University.
Ann Plast Surg. 2020 Jan;84(1S Suppl 1):S7-S10. doi: 10.1097/SAP.0000000000002170.
Pulmonary complications are common among patients who have undergone major oral cancer surgery with microvascular reconstruction. Current literatures focused on early-onset pneumonia in the postoperative acute stage. In contrast, we are aiming to identify the clinical importance and the risk factors associated with late-onset pneumonia in oral cancer patients after acute stage.
In total, 195 patients were included from May 2014 to December 2016 and followed up for up to 1 year after surgery. Their medical histories were reviewed to identify the risk factors of late-onset pneumonia and outcome. Primary outcome was late-onset pneumonia. Other outcome measures included early-onset pneumonia, tumor recurrence, and death within 1 year after surgery.
Patients with late-onset pneumonia have demonstrated a significantly higher rate of tumor recurrence (P < 0.001) and death within 1 year (P < 0.001). Independent risk factors of late-onset pneumonia identified were age (P = 0.031), previous radiotherapy (P = 0.017), postoperative radiotherapy (P = 0.002), flap size (P = 0.001), flap type other than osteocutaneous fibula flap (P = 0.009), and tumor recurrence (P < 0.001).
Late-onset pneumonia can act as a warning sign for oral cancer patients who have received microsurgical reconstruction, for its high correlation with tumor recurrence and mortality rate.
肺部并发症在接受微血管重建的口腔癌大手术患者中很常见。目前的文献主要关注术后急性期的早发性肺炎。相比之下，我们旨在确定口腔癌患者急性期后迟发性肺炎的临床重要性及相关危险因素。
2014年5月至2016年12月共纳入195例患者，术后随访长达1年。回顾他们的病史以确定迟发性肺炎的危险因素和结局。主要结局是迟发性肺炎。其他结局指标包括早发性肺炎、肿瘤复发和术后1年内死亡。
迟发性肺炎患者的肿瘤复发率（P < 0.001）和1年内死亡率（P < 0.001）显著更高。确定的迟发性肺炎独立危险因素为年龄（P = 0.031）、既往放疗（P = 0.017）、术后放疗（P = 0.002）、皮瓣大小（P = 0.001）、除腓骨骨皮瓣以外的皮瓣类型（P = 0.009）和肿瘤复发（P < 0.001）。
迟发性肺炎与肿瘤复发和死亡率高度相关，可作为接受显微外科重建的口腔癌患者的一个警示信号。
