Surgical morbidity and mortality in patients after microvascular reconstruction for head and neck cancer

AbstractBackground:Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.Method:We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.Conclusion:It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.

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Surgical prophylaxis with gram-negative activity for reduction of surgical site infections after microvascular reconstruction for head and neck cancer

Head & Neck ◽

10.1002/hed.24178 ◽

2016 ◽

Vol 38 (10) ◽

pp. 1449-1454 ◽

Cited By ~ 10

Author(s):

Jamie L. Wagner ◽

Rachel M. Kenney ◽

Jose A. Vazquez ◽

Tamer A. Ghanem ◽

Susan L. Davis

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Surgical Site Infections ◽

Microvascular Reconstruction ◽

Surgical Prophylaxis ◽

Gram Negative

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Nutritional Assessment of the Head and Neck Cancer Patient

Otolaryngology ◽

10.1177/019459988008800613 ◽

1980 ◽

Vol 88 (6) ◽

pp. 695-699 ◽

Cited By ~ 4

Author(s):

Matthew J. Lambert

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Cancer Patient ◽

Head And Neck ◽

Neck Cancer ◽

Nutritional Support ◽

Nutritional Assessment ◽

Nutritional Deficiency ◽

Neck Cancer Patient ◽

Morbidity And Mortality

Malnutrition is a common problem in patients with head and neck cancer. Its presence may lead to an increase in morbidity and mortality following an operation, chemotherapy, and radiation therapy. A standard nutritional assessment will define the nature and degree of the nutritional deficiency while periodic reassessment will document the effects of nutritional support.

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Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Scientific Reports ◽

10.1038/s41598-017-15948-8 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Jonas Löfstrand ◽

Kai-Ping Chang ◽

Jennifer An-Jou Lin ◽

Charles Yuen Yung Loh ◽

Hsuan-Yu Chou ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Sequential Analysis ◽

Microvascular Reconstruction

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A nyaki dissectiók onkológiai hozamának maximalizálása a sebészi morbiditás egyidejű minimalizálása mellett

Orvosi Hetilap ◽

10.1556/650.2016.30570 ◽

2016 ◽

Vol 157 (47) ◽

pp. 1871-1879

Author(s):

István Háromi ◽

Imre Gerlinger ◽

László Lujber ◽

Balázs Bendegúz Lőrincz

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Surgical Techniques ◽

Neck Surgery ◽

Surgical Morbidity ◽

Statistical Comparison ◽

Regional Lymphadenectomy ◽

Treatment Review ◽

Nodal Yield

Cervical regional lymphadenectomy, also known as neck dissection, is a fundamental procedure in head and neck surgery. Its evolution over 110 years resulted in a great deal of confusion in the literature and in clinical practice, due to the heterogenicity in training, classification and surgical techniques, which makes outcomes comparability virtually impossible. The authors aim to clarify this situation in a structured manner, in order to facilitate communication among all specialists involved in multidisciplinary head and neck cancer care. The ultimate goal is to make sure that each and every head and neck cancer patient receives their optimal treatment. Review of the history and literature with statistical comparison of the two mainstraim methods regarding their nodal yield results. The applied surgical technique has a significant impact on nodal yield. An appropriate surgical concept achieves maximum oncologic benefit, minimum surgical morbidity with optimized adjuvant indications. Orv. Hetil., 2016, 157(47), 1871–1879.

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Reirradiation After Surgery and Microvascular Reconstruction

Otolaryngology ◽

10.1016/j.otohns.2008.05.501 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P93-P93

Author(s):

Jeffrey D. Suh ◽

Brian Paul Kim ◽

Elliot Abemayor ◽

Joel A Sercarz ◽

Vishad Nabili ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Salvage Surgery ◽

Late Complications ◽

Microvascular Reconstruction ◽

Increased Risk ◽

Cord Injury ◽

Recurrent Head

Problem To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and microvascular reconstruction. Methods Retrospective Study. Twelve patients underwent salvage surgery with microvascular reconstruction for recurrent or new primary head and neck cancer in a previously irradiated field. Median prior RT dose was 63.0 Gy (range 30.0–72.8). Patients then underwent postoperative reirradiation, receiving a median total cumulative radiation dose of 115.0 Gy. Results Three patients (25%) experienced acute complications (<3 months) during reirradiation that resolved with conservative care. Four patients (33%) developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure. No patients suffered brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. There were no treatment-related mortalities. Six patients (50%) are alive without evidence of recurrent disease a median of 40 months after reirradiation (range 4–64 months). Conclusion Free flap reconstruction followed by reirradiation is not associated with an increased risk of perioperative, acute, or late complications. Microvascular free flaps allow for maximal resection and reliable reconstruction of previously irradiated cancers before high dose reirradiation, and may reduce the incidence of severe late complications and treatment related mortality. Significance Reirradiation for recurrent head and neck squamous cell carcinoma remains controversial. However, increasing evidence has demonstrated improved survival and locoregional control with reirradiation at the cost of potentially severe or sometimes fatal radiation toxicity. We hypothesize that using well-vascularized tissue and bone at the time of salvage surgery can reduce the incidence of reirradiation complications. This would allow patients at high risk for recurrence to more safely receive a second course of radiation therapy. To our knowledge this is the first report of the effects of microvascular reconstruction on complications and outcomes of patients undergoing salvage surgery and external beam reirradiation.

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Surveillance Imaging Following Head and Neck Cancer Treatment and Microvascular Reconstruction

The Laryngoscope ◽

10.1002/lary.29700 ◽

2021 ◽

Author(s):

Adrian E. House ◽

Aaron L. Zebolsky ◽

Joanna Jacobs ◽

Ilya Likhterov ◽

Spencer Behr ◽

...

Keyword(s):

Head And Neck Cancer ◽

Cancer Treatment ◽

Head And Neck ◽

Neck Cancer ◽

Microvascular Reconstruction ◽

Surveillance Imaging

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Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction

Otolaryngology ◽

10.1177/0194599818756299 ◽

2018 ◽

Vol 159 (1) ◽

pp. 59-67 ◽

Cited By ~ 7

Author(s):

Michael P. Veve ◽

Joshua B. Greene ◽

Amy M. Williams ◽

Susan L. Davis ◽

Nina Lu ◽

...

Keyword(s):

Risk Factors ◽

Head And Neck Cancer ◽

Antibiotic Prophylaxis ◽

Head And Neck ◽

Neck Cancer ◽

Tertiary Care ◽

Surgical Site Infections ◽

Cross Sectional Study ◽

Microvascular Reconstruction ◽

Cross Sectional

Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

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