Impact of C3 Vertebra-Based Sarcopenia and Clinical Factors on Postoperative Complications in Oral Cancer Patients

Background/Objectives: Recent meta-analyses have established that factors such as sarcopenia, male sex, and low serum albumin significantly correlate with increased postoperative complications in head and neck surgery, with routine neck computed tomography (CT) at the third cervical vertebra (C3) serving as a practical tool for muscle mass assessment. This study aimed to confirm the prognostic value of C3-based sarcopenia and specific clinical comorbidities in predicting early postoperative complications in patients with oral squamous cell carcinoma (OSCC). Methods: A retrospective cohort study was conducted on 167 patients undergoing primary surgery for OSCC. Sarcopenia was assessed using the C3-vertebra skeletal muscle index (SMI) derived from routine preoperative neck CT scans. Clinical and surgical variables, including preoperative serum albumin levels, comorbidities, and flap reconstruction types, were evaluated. A priori multivariate logistic regression models were utilized to identify independent predictors of surgical site and pulmonary and total complications (Clavien-Dindo classification) within 30 days. Results: The overall complication rate was 51%. Multivariate analysis revealed that sarcopenia (aOR: 3.26; 95% CI: 1.11-9.56), male sex (aOR: 3.48; 95% CI: 1.11-10.85), coronary artery disease (CAD) (aOR: 4.30; 95% CI: 1.21-15.36), and free-flap reconstruction (aOR: 15.06; 95% CI: 2.47-92.01) were robust independent predictors of total complications. Male sex (aOR: 4.17; 95% CI: 1.51-11.58) and preoperative hypoalbuminemia (<3.5 g/dL) (aOR: 3.43; 95% CI: 1.20-9.82) were independent predictors of surgical site complications, while regional flap reconstruction was independently associated with pulmonary complications (aOR: 5.97; 95% CI: 1.38-25.97). Conclusions: Sarcopenia, male sex, CAD, and flap reconstruction type are strong independent predictors of postoperative morbidity in OSCC. These findings advocate for "opportunistic screening" of muscle mass via routine preoperative neck CT, alongside rigorous cardiovascular profiling, to identify high-risk phenotypes for targeted perioperative optimization.