Role of reconstructive surgery in the management of head and neck cancer: A national outcomes analysis of 11,841 reconstructions

Nouraei, S.A.R.; Middleton, Steve; Hudovsky, A.; Branford, Olivier A.; Lau, Clement; Clarke, Peter; Wood, Simon; Aylin, Paul; Mace, Alasdair; Jallali, Navid; Darzi, Ara

doi:10.1016/j.bjps.2014.11.011

Cited by 17 publications

(20 citation statements)

References 17 publications

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“…[8][9][10]18 Simultaneously, oncological techniques have advanced and radical ablative and reconstructive surgery has been indicated for patients with recurrences, which may be related to the slight increase in the number of oncological salvage surgeries. 19 In our material, the majority of free flaps were single fasciocutaneous flaps, mostly radial forearm and anterolateral thigh flaps. At the beginning of our study, RFA dominated the reconstructive landscape; but, in the early 2000s ALT emerged as the workhorse flap.…”

Section: Discussionmentioning

confidence: 81%

Evolution of Head and Neck Microvascular Reconstructive Strategy at an Academic Centre: An 18-Year Review

Husso

Mäkitie

Vuola

et al. 2016

J reconstr Microsurg

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Background A remarkable development through the evolution of free flap techniques has led to the modern reconstructive head and neck surgery. This study aimed to review experiences from head and neck free-flap reconstructions performed at our institution over an 18-year period. Methods Between 1995 and 2012, 594 free-flap operations were performed on 541 head and neck patients at the Department of Plastic Surgery, Helsinki University Hospital, Finland. We retrospectively recorded hospital chart data regarding patient demographics, tumor characteristics, surgical treatment, and outcome. Results The mean age of patients increased from 53 years (1995-2000) to 56 (2007-2012), while the gender distribution remained constant (60% males). The most commonly used flap type between 1995 and 2000 was radial forearm flap (50%), while during the periods of 2001 through 2006 and 2007 through 2012 the anterolateral thigh flap was the most common method (42 and 36%, respectively). The number of different flap types and flap combinations increased during these periods (15 flap types during 1995 through 2000; 17 flap types during 2001 through 2006; and 24 flap types during 2007 through 2012). Despite a wider range of flap options used during the period 2001 through 2012, the overall flap survival rate (97%) remained constant. The prevalence of surgical complications decreased from 26% (2001 through 2006) to 21% (2007 through 2012). Conclusions During the study period, the number of flap types increased and reconstructions became more individualized. The overall surgical complication rate decreased although the mean age of patients increased.

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Section: Discussionmentioning

confidence: 81%

Evolution of Head and Neck Microvascular Reconstructive Strategy at an Academic Centre: An 18-Year Review

Husso

Mäkitie

Vuola

et al. 2016

J reconstr Microsurg

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“…Benchmarking and improving the quality of surgical care in this context is predicated on near‐complete case accrual into a dataset which contains clinically relevant stratification and outcome variables . We have previously used the administrative dataset to perform a national benchmarking exercise as well as an assessment of the trends and outcomes associated with flap‐based reconstruction in head and neck cancer surgery . The purpose of the present study was to develop a quality‐assurance framework focusing on a range of perioperative outcomes of head and neck cancer surgery, and to undertake an evaluation of the intrinsic accuracy of the administrative data for this purpose.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who had a mandibulectomy or floor‐of‐mouth resections (RS 3 ) had a significantly higher incidence of this outcome (10.6%) and the incidence in patients who had extensive oral‐pharyngeal resections (RS 4 ) was 11.9%. It is possible that this difference is due to the fact that extensive oral‐pharyngeal resections expose the airway and the vessels and viscera of the neck to digestive tract secretions and as a possible corollary, we have previously found that lethality of reconstructive failure increases with ‘deeper’ resections . The incidence of in‐hospital death or failure to rescue a complication in laryngectomy patients (RS 5 ) was 9.3% and the highest incidence was observed in patients who had undergone pharyngolaryngectomy (RS 6 ; 16.8%).…”

Section: Discussionmentioning

confidence: 99%

“…More than one of these codes is typically present in a reconstructive case and the algorithm was designed for maximum specificity. The algorithm for identifying flap‐based reconstruction was validated and was found to have a sensitivity of 91.1% [95% CI 87–94.3] and a specificity of 99.2% [95% CI 97–99.9] . Case ascertainment logic was therefore [Head and Neck Cancer Diagnosis = Yes AND (Tier‐1 resection = Yes OR (Tier‐2 resection = Yes AND (Flap‐base reconstruction = Yes OR tracheostomy = Yes)))].…”

Section: Methodsmentioning

confidence: 99%

“…We have previously developed and validated an algorithm for identifying major head and neck cancer surgery within hospital administrative data and have used it to perform a national benchmarking exercise for major head and neck cancer surgery . We also investigated trends in reconstructive surgery and the impact of reconstructive failure on perioperative outcome . In this study, we propose a more generalised HES‐based stratified outcomes assessment framework for major head and neck cancer surgery.…”

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confidence: 99%

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A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics‐based Outcomes Surveillance Framework

Nouraei

Mace

Middleton

et al. 2016

Clinical Otolaryngology

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Potential of the common facial vein as a recipient vein in free flap reconstruction

2021

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Recipient vessel selection for free flap reconstruction depends on numerous factors and may be limited due to previous treatment. Currently, little evidence is available regarding the anatomy and reconstructive potential of the common facial vein (CFV), a tributary of the internal jugular vein (IJV). The aim of this project was to determine the diameter of the CFV at various points along its course and identify suitable landmarks to locate the CFV, to consider the vessel as a potential recipient vein in free flap reconstruction. A cadaveric study was conducted by dissecting 17 embalmed neck hemi-sections in the Keele University Medical School Anatomy Suite. Our intent was to describe the gross anatomy of the CFV in terms of diameter and relation to surrounding structures. We found the mean diameter of the CFV to be 5.9 (± 1.8) mm at its termination into the IJV. We also found the mean distance of the CFV termination into the IJV from the level of the hyoid bone was 8.0 (± 4.0) mm. The diameter of the CFV could accommodate for end-to-end anastomoses to be formed with the IJV system. The diameter also suggests the vein to be appropriate for microvascular anastomosis with commonly used free flaps. The results propose that the CFV can be found within 12 mm of the level of the hyoid bone, knowledge of which could reduce operative time and site morbidity. These findings support the CFV as a potential recipient vein in free flap reconstruction of the head and neck.

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Role of reconstructive surgery in the management of head and neck cancer: A national outcomes analysis of 11,841 reconstructions

Cited by 17 publications

References 17 publications

Evolution of Head and Neck Microvascular Reconstructive Strategy at an Academic Centre: An 18-Year Review

Evolution of Head and Neck Microvascular Reconstructive Strategy at an Academic Centre: An 18-Year Review

A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics‐based Outcomes Surveillance Framework

Potential of the common facial vein as a recipient vein in free flap reconstruction

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