Early Modification in Drainage of Interleukin-1β and Tumor Necrosis Factor-α Best Predicts Surgical-Site Infection After Cervical Neck Dissection for Oral Cancer

Purpose: Surgical-site infection (SSI) after cervical neck dissection (CND) for head and neck squamous cell carcinoma (HNSCC) increases morbidity and delays adjuvant treatment. This study assessed changes in cytokines levels in postsurgical drainage fluid after CND and examined their predictive value for the early diagnosis of SSI. Patients and Methods: An observational prospective pilot study was conducted in 39 consecutively recruited patients with HNSCC undergoing CND who were treated at the authors' service within the past 2 years. Patients met the following inclusion criteria: no previous chemotherapy or radiotherapy, closed-suction drainage, 30-day follow-up, prophylactic treatment with amoxicillin plus clavulanic acid and dexamethasone, no chronic inflammatory disease, and no previous neck surgery. Drainage samples were collected at postoperative days +1 and +3. Sample size was estimated based on SSI incidence after HNSCC surgery (similar to 15%; alpha risk, 0.05; beta risk, 0.2; 2-sided test). Interleukin (IL)-1 beta, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-alpha) levels were measured. Patients were followed to detect SSI. Sensitivity, specificity, and prognostic values were calculated for each cytokine at days +1 and +3 to diagnose SSI. Results: SSI was diagnosed in 6 of 39 patients. Bilateral CND, tracheostomy, surgery duration longer than 7 hours, HNSCC stage T3 or T4, and reconstruction with pedicled flaps versus microvascular flaps for advanced-stage tumors were considered risk factors for SSI. All cytokines except IL-10 showed statistical differences between patients with SSI and those without SSI. The best receiver operating characteristic curves yielded cutoff values at day +1 (TNF-alpha >14.5 pg/mL; sensitivity, 100%; specificity, 87.88%) and day +3 (IL-1 beta >115 pg/mL; sensitivity, 83.33%; specificity, 78.79%). Also, IL-2 levels higher than 6.5 pg/mL at day +1 (sensitivity, 83.33%; specificity, 69.7%) and day +3 (sensitivity, 100%; specificity, 69.7%) and IL-6 levels higher than 3,300 pg/mL at day +3 (sensitivity, 100%; specificity, 60.61%) yielded adequate diagnostic profitability. Conclusion: The results of this study suggest that the assessment of cytokine levels in drainage fluid soon after CND could provide a novel method for the early detection of SSI. (C) 2015 American Association of Oral and Maxillofacial Surgeons