Purpose: Sarcopenia is characterized by depletion of skeletal muscle mass (SMM) and can cause increased postoperative complication in free flap procedure. One of the most important considerations while deciding the indication of the procedure is patients' survival. This study aimed to verify the relationship between low SMM and survival in patients who undergo oral cancer resection using free flap. Methods: SMM was evaluated using the skeletal muscle index (SMI cm2/m2), which was defined using cross-sectional areas of skeletal muscles on computed tomography at the level of the third lumbar vertebrae normalized for height. Overall, 111 patients who underwent primary oral cancer resection and free flaps were included. Multivariate Cox regression analyses were used to evaluate the prognostic factors for survival. Results: A total of 25 patients (22.5%) were diagnosed with low SMM. The mean SMI was 42.2 cm2/m2. Multivariable analyses showed that increased age (hazard ratio [HR]; 4.98, p =.004), infiltrative growth pattern INF-c (HR; 3.83, p =.037), and low SMM (HR; 2.59, p =.034) were significant negative prognostic factors for overall survival. Increased age (HR; 3.18, p =.005), extra-nodal extension (HR; 3.30, p =.001), and low SMM (HR; 2.42, p =.017) were significant negative prognostic factors for disease-free survival. Conclusions: Low SMM is a significant negative prognostic factor for overall and disease-free survival in oral cancer patients undergoing free flap. Future prospective studies are warranted to identify effective preoperative exercise and nutrition programs to improve low skeletal muscle and survival rate in patients undergoing free flap procedures.
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