841 Poster Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer — A DAHANCA survey

Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.

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Swallowing and Tongue Function Following Treatment for Oral and Oropharyngeal Cancer

Journal of Speech Language and Hearing Research ◽

10.1044/jslhr.4304.1011 ◽

2000 ◽

Vol 43 (4) ◽

pp. 1011-1023 ◽

Cited By ~ 143

Author(s):

Cathy L. Lazarus ◽

Jeri A. Logemann ◽

Barbara Roa Pauloski ◽

Alfred W. Rademaker ◽

Charles R. Larson ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Oropharyngeal Cancer ◽

Control Group ◽

Tongue Strength ◽

Oral Performance ◽

Control Subjects ◽

Oral And Oropharyngeal Cancer ◽

Primary Radiotherapy

This study examined tongue function and its relation to swallowing in 13 subjects with oral or oropharyngeal cancer treated with primary radiotherapy ± chemotherapy and 13 age- and sex-matched control subjects. Measures of swallowing and tongue function were obtained using videofluoroscopy, pretreatment and 2 months posttreatment. Maximum isometric strength and endurance at 50% of maximum strength were obtained with the Iowa Oral Performance Instrument (IOPI). Control subjects were tested once. All subjects with head and neck cancer were evaluated pretreatment and 2 months posttreatment. No significant differences were found for the tongue function measures pre- and 2 months posttreatment in the group with head and neck cancer. Significantly higher tongue strength was observed in the control than in the group with head and neck cancer both pre- and posttreatment. No significant differences were found for the 2 groups for tongue endurance measures. Significant correlations of tongue strength and endurance and some swallow measures were found pre- and posttreatment for the group with head and neck cancer and for the control group. These correlations included oral and pharyngeal temporal swallow measures and oropharyngeal swallow efficiency. Pretreatment differences between the 2 groups in tongue strength were likely related to tumor bulk, pain, and soreness. Two-month posttreatment differences were likely related to radiation ± chemotherapy changes to the oral and pharyngeal mucosa. This study provides support for the hypothesis that tongue strength plays a role in oropharyngeal swallowing, particularly related to the oral phase of the swallow.

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Stress and depression in head and neck cancer patients by primary surgery versus primary radiotherapy treatment modality.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.5597 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 5597-5597 ◽

Cited By ~ 2

Author(s):

C. A. Jensen ◽

J. J. Hu ◽

L. D. Case ◽

J. D. Browne ◽

J. Gilbert ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Treatment Modality ◽

Primary Surgery ◽

Primary Radiotherapy ◽

Radiotherapy Treatment

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Recurrent head and neck cancer: United Kingdom National Multidisciplinary Guidelines

The Journal of Laryngology & Otology ◽

10.1017/s002221511600061x ◽

2016 ◽

Vol 130 (S2) ◽

pp. S181-S190 ◽

Cited By ~ 34

Author(s):

H Mehanna ◽

A Kong ◽

SK Ahmed

Keyword(s):

Computed Tomography ◽

Head And Neck Cancer ◽

Supportive Care ◽

Head And Neck ◽

Neck Cancer ◽

Transoral Surgery ◽

Partial Laryngectomy ◽

Management Options ◽

Salvage Laryngectomy ◽

Recurrent Head

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Recurrent cancers present some of the most challenging management issues in head and neck surgical and oncological practice. This is rendered even more complex by the poor evidence base to support management options, the substantial implications that treatments can have on the function and quality of life, and the difficult decision-making considerations for supportive care alone. This paper provides consensus recommendations on the management of recurrent head and neck cancer.Recommendations• Consider baseline and serial scanning with computed tomography and/or magnetic resonance (CT and/or MR) to detect recurrence in high-risk patients. (R)• Patients with head and neck cancer recurrence being considered for active curative treatment should undergo assessment by positron emission tomography combined with computed tomography (PET–CT) scan. (R)• Patients with recurrence should be assessed systematically by a team experienced in the range of management options available for recurrence including surgical salvage, re-irradiation, chemotherapy and palliative care. (R)• Management of patients with laryngeal recurrence should include input from surgeons with experience in transoral surgery and partial laryngectomy for recurrence. (G)• Expertise in transoral surgery and partial laryngectomy for recurrence should be concentrated to a few surgeons within each multidisciplinary teams. (G)• Transoral or open partial laryngectomy should be offered as definitive treatment modality for highly-selected patients with recurrent laryngeal cancer. (R)• Patients with OPC recurrence should have p16 human papilloma virus status assessed. (R)• Patients with OPC recurrence should be considered for salvage surgical treatment by an experienced team, with reconstructive expertise input. (G)• Transoral surgery appears to be an effective alternative to open surgery for the management of OPC recurrence in carefully selected patients. (R)• Consider elective selective neck dissections in patients with recurrent primaries with N0 necks, especially in advanced cases. (R)• Selective neck dissection (with preservation of nodal levels, especially level V, that are not involved by disease) in patients with nodal (N+) recurrence appears to be as effective as modified or radical neck dissections. (R)• Use salivary bypass tubes following salvage laryngectomy. (R)• Use interposition muscle-only pectoralis major or free flap for suture line reinforcement if performing primary closure following salvage laryngectomy. (R)• Use inlaid pedicled or free flap to close wound if there is tension at the anastomosis following laryngectomy. (R)• Perform secondary puncture in post chemoradiotherapy laryngectomy patients. (R)• Triple therapy with platinum, cetuximab and 5-fluorouracil (5-FU) appears to provide the best outcomes for the management of patients with recurrence who have a good performance status and are fit to receive it. If not fit, then combinations of platinum and cetuximab or platinum and 5-FU may be considered. (R)• Patients with non-resectable recurrent disease should be offered the opportunity to participate in phases I–III clinical trials of new therapeutic agents. (R)• Chemo re-irradiation appears to improve locoregional control, and may have some benefit for overall survival, at the risk of considerable acute and late toxicity. Benefit must be weighed carefully against risks, and patients must be counselled appropriately. (R)• Target volumes should be kept tight and elective nodal irradiation should be avoided. (R)• Best supportive care should be offered routinely as part of the management package of all patients with recurrent cancer even in the case of those who are being treated curatively. (R)

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