Perioperative predictors of outcomes in head and neck cancer surgery: A prospective observational analysis.

Abstract

234 Background: Surgical outcomes in head and neck cancer (HNC) are influenced by patient-related factors (nutritional status, comorbidities), disease-related factors (tumor stage and type), and perioperative variables (surgical duration, anesthetic management). Despite the high global incidence of HNC, comprehensive prospective data evaluating perioperative predictors of outcomes remain limited, highlighting the need for systematic investigation in this area. Methods: This prospective, single-center observational study was conducted following Institutional Ethics Committee approval and prospective CTRI registration (CTRI/2025/10/096289; registered on 22/10/2025). Patient enrollment began on 05/11/2025. Adults undergoing major HNC surgery were included. Data collected encompassed demographics, comorbidities, medications, nutritional status, and detailed intraoperative anesthetic variables, including fluid therapy, vasopressor use, duration of hypotension, and blood loss. The primary outcome was a composite of 30-day major complications (Clavien–Dindo grade ≥III) and mortality. The planned sample size is 1,540 participants, with a recruitment period of two years and an additional one-year follow-up. Interim analyses were performed on the initial cohort. Results: In the first 100 enrolled patients (mean age 52 years; 74% male), comorbidity burden was substantial (ASA ≥III: 20%; median Caprini score: 5). Major complications or death within 30 days occurred in 15% of patients. Increased intraoperative blood loss emerged as the strongest independent predictor of adverse outcomes, while higher Caprini scores showed a trend toward increased risk. These findings highlight blood loss as a key modifiable perioperative factor and support the utility of the Caprini score for preoperative risk stratification in HNC surgery. Conclusion: Preliminary results from this ongoing study demonstrate a high prevalence of nutritional deficits and intraoperative hemodynamic instability in patients undergoing major HNC surgery. These perioperative factors represent potential targets for intervention to improve early postoperative outcomes. Continued recruitment and long-term follow-up are underway to further clarify predictors of short- and long-term survival. Conflict of Interest: None declared. Funding: Investigator-initiated study with no external funding. Characteristic All patients (N=100) No major comp. (n=85) Major comp. (n=15) p-value Age (years), mean ± SD 52.4 ± 11.9 51.6 ± 11.7 56.9 ± 12.1 0.098 BMI (kg/m²), mean ± SD 24.1 ± 4.5 24.3 ± 4.6 23.2 ± 3.5 0.386 ASA grade ≥3 20 (20.0) 14 (16.5) 6 (40.0) 0.045 Caprini score, median (IQR) 5 (5–6) 5 (5–6) 6 (5–7) 0.029 Surgery duration (min), mean ± SD 342 ± 82 334 ± 78 386 ± 96 0.023 Blood loss (mL) median (IQR) 700 (500–900) 650 (400–850) 900 (700–1200) 0.005