Postoperative morbidity of free flaps in head and neck cancer reconstruction: a report regarding 215 cases

Poisson, Maria; Longis, Julie; Schlund, Matthias; Péré, Morgane; Michel, Guillaume; Delagranda, A.; Mouawad, F.; Piot, B.; Bertin, Hélios

doi:10.1007/s00784-018-2653-1

Cited by 14 publications

(15 citation statements)

References 40 publications

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“…However, recent work in the field of head and neck surgery has demonstrated convincing evidence that initiation of oral diet on POD-1 reduces the length of stay without an increase in perioperative complications [75] . More compelling evidence now supports older studies that had occasionally shown that rates of fistula formation were not increased by early oral feeding [76][77][78][79] . Together with the aforementioned promising data seen in the general surgery populations, these findings suggest that oral feeding as early as postoperative day one is likely to improve dysphagia outcomes, quality of life, and length of stay in patients after head and neck oncologic surgery.…”

Section: Early Diet Initiationsupporting

confidence: 71%

Enhanced recovery and medical management after head and neck microvascular reconstruction

Gidumal¹,

Worrall²,

Phan³

et al. 2021

PAR

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Protocols to enhance and expedite recovery after surgery originally developed through efforts in gastrointestinal, colorectal, and thoracic surgery populations. Implementation of specific evidence-based interventions undertaken in the perioperative setting has been shown to decrease the length of stay, reduce cost, and improve patient outcomes and satisfaction. The basic tenets of enhanced recovery protocols are to reduce physiologic stress in the perioperative setting, improve nutritional status before and after surgery, promote respiratory and physical rehabilitation, and encourage frequent and recurring reassessment for quality improvement. Some interventions, such as the use of deep vein thrombosis prophylaxis in the perioperative setting, are now well established across surgical populations; however, the increased attention to these protocols has led to new innovative interventions in the head and neck population. This review highlights these innovative interventions designed to enhance recovery after major surgery, lends particular focus to the biological mechanisms behind these interventions, and describes their relevance to the head and neck population.

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Section: Early Diet Initiationsupporting

confidence: 71%

Enhanced recovery and medical management after head and neck microvascular reconstruction

Gidumal¹,

Worrall²,

Phan³

et al. 2021

PAR

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“…Immediate flap reconstruction is generally associated with fewer POCs, a shorter hospital stay, reduced treatment costs and more favorable aesthetic and functional outcomes than cancer resection without flap reconstruction (22). However, reconstructive surgery using a microvascular free flap is also considered to be a great challenge, as it may lead to a longer operation time and more blood loss, both of which have been demonstrated to be associated with a high incidence of POCs (23,24). Therefore, the significance of free flap reconstruction in the prognosis and occurrence of complications in HNSCC patients is complicated (25).…”

Section: Discussionmentioning

confidence: 99%

Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data

Wang

Wei

et al. 2022

Front. Oncol.

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BackgroundPostoperative complications (POCs) of moderate-advanced head and neck squamous cell carcinoma (HNSCC) after free flap reconstruction have received little attention. We investigated the risk factors that lead to POCs and their impact on management and prognosis.Patients and MethodsA single-center, prospective cohort study was conducted at Beijing Stomatological Hospital on primary HNSCC patients treated between 2015 and 2020.ResultsIn total, 399 consecutive HNSCC patients who underwent radical resection of the primary tumor and free flap reconstruction were enrolled in this study, 155(38.8%) experienced POCs. The occurrence of POCs directly led to worse short-term outcomes and poorer long-term overall survival (P=0.0056). Weight loss before the operation (P=0.097), Tumor site (P=0.002), stage T4b (P=0.016), an ACE-27 index of 2-3 (P=0.040), operation time≥8h (P=0.001) and Clindamycin as antibiotic prophylaxis (P=0.001) were significantly associated with POCs.ConclusionsThe occurrence of POCs significantly leads to worse short-term outcomes and increases the patients’ burden.

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“…Minor post-operative complications were noted with three patients who experienced small orocutaneous fistulae, which spontaneously resolved with medical treatment (antibiotics) and a period of NBM status. In one study reporting on risk factors for post-operative complications, the patients who experienced orocutaneous fistulae had large T3/T4 tumours with N2b/N2c neck disease and required tracheostomy [ 6 ]. One patient experienced flap loss; however, this patient had been NBM due to swallowing difficulties and had a neck infection at the time of flap loss on day 9.…”

Section: Discussionmentioning

confidence: 99%

“…One patient experienced flap loss; however, this patient had been NBM due to swallowing difficulties and had a neck infection at the time of flap loss on day 9. Post-operative infection has been described previously as a risk factor for post-operative complications including flap loss [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent large multicentre retrospective review of over 200 patients investigated the risk factors for free flap failure, surgical complications and the non-oral feeding period in patients treated for oral squamous cell carcinoma with reconstructive free tissue transfer reconstruction [ 6 ]. The majority of patients had floor of mouth, tongue or mandibular tumours and the majority of reconstructions included forearm fasciocutaneous flap (39.5%) or a fibular osseous free flap (30.8%).…”

Section: Introductionmentioning

confidence: 99%

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Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

et al. 2021

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Traditionally patients can remain nil by mouth (NBM) for up to 12 days after oral tumour resection with free flap reconstruction to reduce the risk of flap dehiscence, poor healing and fistulae. The literature reports that patients could on average remain an inpatient for up to 20 days post-surgery. An evaluation of the impact of a defined early oral feeding protocol was undertaken investigating functional outcomes and complications rates. We prospectively reviewed tracheostomy use, length of hospital stay, non-oral feeding status and swallowing function using the Performance Status Scale for Head and Neck Cancer (PSS-HN) within a defined early feeding protocol. Twenty-nine patients underwent surgical resection with free flap reconstruction for advanced primary oral cancer between January 2018 and December 2019. Average age was 59.5 (range 24–88). Tumour sites included oral tongue (n = 10), maxilla (n = 6), mandible (n = 6), floor of mouth (n = 5) and buccal mucosa (n = 2). Median time to decannulation was 7 days (range 3–20 days, n = 11). The majority of patients were able to tolerate at least oral fluids on day 1 post-operatively (86%, n = 25). In addition to oral intake, non-oral feeding was required in 90% (n = 26), the majority of which included a nasogastric tube (NGT) placed intraoperatively 54% (n = 14), others required gastrostomy 46% (n = 12). Median time to nasogastric tube removal was 6 days (range 3–15 days). Median length of hospital stay was 10 days (range 3–51). Mean PSS-Normalcy of Diet (NOD) score at point of hospital discharge was 36.55 (95% CI 30.9–42.2). Flap failure was noted in 3% (n = 1). The adoption of an early oral feeding protocol suggests that there is the potential for a shorter hospital stay and earlier swallowing rehabilitation.

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Postoperative morbidity of free flaps in head and neck cancer reconstruction: a report regarding 215 cases

Cited by 14 publications

References 40 publications

Enhanced recovery and medical management after head and neck microvascular reconstruction

Enhanced recovery and medical management after head and neck microvascular reconstruction

Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data

Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

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