Perioperative Blood Transfusion in Head and Neck Cancer Revisited

Abstract

Objective To reevaluate the frequency of perioperative blood transfusion, transfusion triggers, and survival impact in patients with incident, surgically treated head and neck cancer (HNC) in restrictive transfusion regimens. Methods Retrospective analysis of surgically treated patients with incident HNC with and without perioperative blood transfusion between 2008 and 2019 at the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, according to the department's clinical Head and Neck Tumor Registry. Results Of the 590 patients included, perioperative transfusions were administered in 6.3% (n = 37, transfusion group). Following multivariable logistic regression, likelihood of blood transfusions was increased in patients with poorer general health conditions (ASA score III/IV; OR 3.7; 95% CI 1.9–8.6; p = 0.002), hemoglobin <12.5 g/dL (OR 2.7; 95% CI 1.1–6.4; p = 0.03), longer duration of surgery (OR 1.006 per minute of surgery time; 95% CI 1.003–1.008; p < 0.001), and negative p16 status (OR 5.3; 95% CI = 1.1–25; p = 0.03). Based on 14 matching variables related to survival and perioperative blood transfusion, a control group of 37 matching patients without perioperative transfusion was identified. Using univariate analysis, overall survival in transfusion and control groups did not differ significantly (p = 0.25). After adjusting for four parameters with limited matching accuracy (Chi square p < 0.2) in Cox regression analysis, a transfusion related hazard ratio close to 1 (HR 0.92; 95% CI 0.34–2.51; p = 0.87) was observed. Conclusion Considering current restrictive transfusion regimens and general transfusion risks, the administration of blood products in HNC patients during the perioperative period is not associated with additional oncologic hazard. Level of Evidence 3 Laryngoscope, 133:1638–1644, 2023

Analysis of cells of epithelial, connective tissue and immune differentiation in HPV-positive-, HPV-negative oropharyngeal carcinoma and normal oropharyngeal tissue by immunofluorescence multiplex image cytometry: a preliminary report

“…Inclusion criteria were histologically confirmed squamous cell carcinoma of the oropharynx, known high risk HPV-status by p16 immunohistochemistry [ 22 ], and patient consent to use anonymized data and tissue samples for scientific investigations and publications. A commercial in vitro diagnostic certified assay containing a ready-to-use prediluted mouse monoclonal antibody was used for p16 detection (CINtec® Histology V-Kit, Roche Ventana, Tucson, AZ, USA) [ 23 ]. The definition of an HPV + tumor was based on the overexpression of p16.…”

Enhanced recovery after surgery, current, and future considerations in head and neck cancer

“…Decreased OS, increased wound infections, flap failures, and hospital readmission rates were all found to be associated with perioperative blood transfusions 198,201–203 . A recent study published by Runge et al concluded that current transfusion practices do not increase oncologic risk or decrease OS over a 5 year period; however, this study included only a limited number of patients 204 …”

“… 198 , 201 , 202 , 203 A recent study published by Runge et al concluded that current transfusion practices do not increase oncologic risk or decrease OS over a 5 year period; however, this study included only a limited number of patients. 204 …”