Association between oral cancer surgery and postoperative airway obstruction: A retrospective study

Objective

Predicting postoperative airway obstruction during oral cancer surgery is difficult. We aimed to investigate the relationship between postoperative airway obstruction and surgery in patients.

Methods

Patients (n = 100, men: 72, women: 28) with oral malignancies who underwent surgery between January 2020 and December 2022 were included. The outcome was postoperative airway obstruction. Age, sex, alcohol, smoking history, BMI, tumor site, T and N classification, stage, surgical method, lymphatic invasion, vascular invasion, perineural invasion, DOI, airway management, occurrence and duration of postoperative airway obstruction were investigated. We defined airway obstruction as confirmed symptoms such as dyspnoea and wheezing, drop in SpO2 below 90 %, stridor auscultation and pharyngeal stenosis by endoscope.

The relationship between airway obstruction and patient characteristics was analyzed using Fisher's exact test. The Kaplan–Meier method was used to assess onset of airway obstruction, and the time to onset of airway obstruction was compared using the log-rank test. Airway obstruction and surgery-related factors were evaluated using Cox regression models.

Results

Airway obstruction occurred in 6 patients within 12 h. Multivariate analysis revealed that age > 65 years, lymphatic invasion and DOI (cut-off value: 7.00 mm) were independent risk factors for occurrence of airway obstruction.

Conclusion

Local resection of tumors ≥ 7 mm in DOI is associated with airway obstruction owing to factors such as swelling associated with deep resection. Age, lymphatic invasion are also associated with airway obstruction, requiring ward management according to the protocols of each institution with attention to postoperative hematoma and edema that may cause airway obstruction.