151751-Najiba-Chargi

134 CHAPTER 7 NLR was significantly associated with increased risk of surgical site infection in HNC patients undergoing major oncologic resection. 56 This study supports this finding. NLR is not only an index of inflammation, but is also known to reflect nutritional status, as the total lymphocyte count is decreased in cases of malnutrition. 57 The exact underlyingmechanismof how lowSMM and elevated NLR attributes to surgical complications is not yet elucidated. Inflammationmay underline muscle wasting and may also be reinforced by it. Inflammatory mediators promote catabolic metabolismwhich leads to increased protein degradation and decreased regenera- tion. Low SMM and high NLR may therefore also interfere with wound healing. Our study has some limitations. Due to the retrospective design of the study, information was not completely available regarding ischemic time, intra-operative hypotension, operative time and anticoagulant administration. These factors are known to (potentially) have an impact on surgical complications. Besides this limitation, our study has also some strengths. Firstly, we included a large sample size with detailed socio-demographic and clinical factors. Secondly, we measured SMM at the level of C3 instead of L3 which minimizes the risk of only includ- ing advanced cases of HNC. Thirdly, this is the first study evaluating the impact of SMM and systemic inflammation in patients undergoing head and neck microvascular reconstruction. Prevention or treatment of low SMM in head and neck patients remains a challenge due to the high prevalence of malnutrition in these patients. It is however worthwhile to study if interventions aimed at preservation and/or gain of SMM such as pre-operative multimodal rehabilitation programs that include nutritional support, physical therapy and motivational psychotherapy could be effective in preventing adverse outcomes associated with low SMM and elevated NLR. Pharmacological interventions and supplements targeting SMMmight also be promising. 58 For example, omega-3-fatty acids may alter body composition by anti-in - flammatory effects and thereby contribute to increased anabolism, improve insulin response and glucose transport and reduce triglyceride accumulation in skeletal muscle. 59 Trials are performed where cachexia in patients with cancer are treated with omega-3 fatty acid supple- mentation and nonsteroidal anti-inflammatory drugs which underlines the interrelationship between inflammation and muscle wasting. 60 CONCLUSIONS SMM and NLR are easily evaluated, non-invasive biomarkers which are associated with an increased risk of complications, longer LOS and decreased survival in patients undergoing microvascular free flap reconstruction in the head and neck area.