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Hidaka T, Miyamoto S, Furuse K, Fukunaga Y, Oshima A, Matsuura K, Higashino T. Evaluation of aesthetic outcomes of mandibular reconstruction using artificial intelligence. Head Neck 2024. [PMID: 38698733 DOI: 10.1002/hed.27797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although vascularized bone graft (VBG) transfer is the current standard for mandibular reconstruction, reconstruction with a mandibular reconstruction plate (MRP) and with a soft-tissue flap (STF) alone remain crucial options for patients with poor general conditions. However, objective aesthetic outcome evaluations for these methods are limited. METHODS In a retrospective analysis of 65 patients (VBG, 33; MRP, 19; and STF, 13), mandibular asymmetry value was calculated for each patient's photograph using facial recognition AI, with a higher value indicating worse asymmetry. RESULTS The MRP group had a value comparable to the VBG group regardless of mandibular defect types. The STF group had a significantly higher value than the VBG group. CONCLUSIONS Regarding cosmesis, STF was inferior to VBG, whereas MRP was comparable to VBG, even for anterior defects for which rigid reconstruction is mandatory. However, MRP's risks of plate-related complications limit its use to cases where VBG is contraindicated or with poor prognosis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Takeaki Hidaka
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shimpei Miyamoto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Hongo, Japan
| | - Kiichi Furuse
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yutaka Fukunaga
- Department of Plastic Surgery, Naruto Hospital, Naruto, Japan
| | - Azusa Oshima
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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2
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Padovan BV, Bijl MAJ, Langendijk JA, van der Laan HP, Van Dijk BAC, Festen S, Halmos GB. Evaluation of a new two-step frailty assessment of head and neck patients in a prospective cohort. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08651-8. [PMID: 38653824 DOI: 10.1007/s00405-024-08651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Assessing frailty, in head and neck cancer (HNC) patients is key when choosing appropriate treatment. Optimal screening is challenging, as it should be feasible and should avoid over-referral for comprehensive geriatric assessment (CGA) This study aims to evaluate the association between geriatric assessment using a new two-step care pathway, referral to geriatrician and adverse outcomes. METHODS This institutional retrospective analysis on a prospective cohort analysed the multimodal geriatric assessment (GA) of newly diagnosed HNC patients. Uni- and multivariable logistic regression was performed to study the association between the screening tests, and referral to the geriatrician for complete geriatric screening, and adverse outcomes. RESULTS This study included 539 patients, of whom 276 were screened. Patients who underwent the GA, were significantly older and more often had advanced tumour stages compared to non-screened patients. Referral to the geriatrician was done for 30.8% of patients. Of the 130 patients who underwent surgery, 26/130 (20%) experienced clinically relevant postoperative complications. Of the 184 patients who underwent (radio)chemotherapy, 50/184 (27.2%) had clinically relevant treatment-related toxicity. Age, treatment intensity, polypharmacy and cognitive deficits, were independently associated with referral to geriatrician. A medium to high risk of malnutrition was independently associated with acute radiation induced toxicity and adverse outcomes in general. CONCLUSION The current study showed a 30.8% referral rate for CGA by a geriatrician. Age, treatment intensity, cognitive deficits and polypharmacy were associated with higher rates of referral. Furthermore, nutritional status was found to be an important negative factor for adverse treatment outcomes, that requires attention.
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Affiliation(s)
- Beniamino Vincenzoni Padovan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M A J Bijl
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H P van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B A C Van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Festen
- University Medical Center Groningen, University Medical Center for Geriatric Medicine, Groningen, The Netherlands
| | - G B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Mourgues C, Balayssac D, Mulliez A, Planeix CM, Feydel G, Biard A, Alaux-Boïko V, Irthum C, Saroul N, Dang NP. Comparison of the microvascular anastomotic Coupler™ system with hand-sewn suture for end to end veno-venous anastomosis for head and neck reconstruction with free flap transfer: Medico-economic retrospective case-control study. J Craniomaxillofac Surg 2024; 52:291-296. [PMID: 38212165 DOI: 10.1016/j.jcms.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024] Open
Abstract
The aim of this study was to assess the medico-economic impact of the MACD Coupler™ system in comparison with HSA for end to end veno-venous anastomosis during free flap transfer. A retrospective case-control study was performed in an academic institution, from March 2019 through July 2021, to analyze medical and economic outcomes of patients managed for head and neck reconstruction with free flap transfer. 43 patients per group were analyzed. Rates of initial success, re-intervention, complications and flap transfer failure were not different between groups. Use of MACD increased the cost of medical devices between Coupler and Control groups with respectively K€ 0.7 [0.5; 0.8] and K€ 0.1 [0.5; 0.8] (p = 0.001) and decreased the cost for operating staff with respectively K€ 4.0 [3.4; 5.2] and K€ 5.1 [3.8; 5.4] (p = 0.03). The total management costs were not different between groups with respectively a total median cost of K€ 18.4 [14.3; 27.2] and K€ 17.3 [14.1; 23.7] (p = 0.03). In conclusion, the cost of the Coupler™ is significant but is partly offset by the decrease in operating staff costs. The choice of one or the other technique can be left to the discretion of the surgeon.
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Affiliation(s)
- Charline Mourgues
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France.
| | - David Balayssac
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France; Université Clermont Auvergne, INSERM U1107, NEURODOL, F-63003, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Claire-Marie Planeix
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Gabrielle Feydel
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Adrien Biard
- CHU Clermont-Ferrand, Service Pharmacie, F-63003, Clermont-Ferrand, France
| | - Véra Alaux-Boïko
- CHU Clermont-Ferrand, Service Pharmacie, F-63003, Clermont-Ferrand, France
| | - Charles Irthum
- CHU Clermont-Ferrand, Service de chirurgie maxillo-faciale et plastique, F-63003, Clermont-Ferrand, France
| | - Nicolas Saroul
- CHU Clermont-Ferrand, Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, F-63003, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, INRAE, UNH, Équipe ASMS, 63000, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Université Clermont Auvergne, INSERM U1107, NEURODOL, F-63003, Clermont-Ferrand, France; CHU Clermont-Ferrand, Service de chirurgie maxillo-faciale et plastique, F-63003, Clermont-Ferrand, France
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4
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Pasick LJ, Tong JY, Benito DA, Sargi Z, Anis MM. Airway fires in otolaryngologic surgery: A database review. Am J Otolaryngol 2023; 44:104003. [PMID: 37478536 DOI: 10.1016/j.amjoto.2023.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE An estimated 34 % of reported operating room fires involve the airway. Despite the inherent risks in otolaryngologic surgery, education regarding prevention and management of airway fires is limited in graduate medical training. One contributing factor is a lack of reporting of such rare events in our literature. METHODS The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to fires occurring during surgical procedures of the airway from January 1, 2010, to March 31, 2020. RESULTS 3687 reports were identified and 49 unique reports of airway fire were included. Sustained fires were described in 16 (32.7 %) reports and 33 (67.3 %) described transient flares. 2 fires extended beyond the airway and 9 (18.4 %) were noted to have occurred at the start of the case. Fires were reported most commonly during tonsillectomy (n = 22 [44.9 %]), vocal fold excision (n = 5 [10.2 %]), and adenoidectomy (n = 4 [8.2 %]). 46 reports attributed flare initiation to a specific element of the fire triangle. 16 patient and 2 operator injuries were reported. Saline washing was utilized in 7 (14.3 %) cases overall. Patients were extubated immediately in 2 (12.5 %) of the 16 reports of sustained fires. 0 mortalities were reported. CONCLUSION Airway fires were reported in a variety of upper airway procedures performed regularly by otolaryngologists. The triggering factor that led to fire was identified as a spark or char in about half of the reported cases, and only 2 reports described immediate removal of the endotracheal tube.
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Affiliation(s)
- Luke J Pasick
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Jane Y Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine. Baltimore, MD, USA
| | - Daniel A Benito
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Florida, Stuart, FL, USA
| | - Zoukaa Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mursalin M Anis
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Bajwa MS, Jackson R, Dhanda J, Tudur Smith C, Shaw RJ, Schache AG. Determining the Effectiveness of Fibrin Sealants in Reducing Complications in Patients Undergoing Lateral Neck Dissection (DEFeND): A Randomised External Pilot Trial. Cancers (Basel) 2023; 15:5073. [PMID: 37894440 PMCID: PMC10605578 DOI: 10.3390/cancers15205073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES High-quality randomised controlled trials (RCT) to support the use of Fibrin Sealants (FS) in neck dissection (ND) are lacking. The DEFeND trial assessed critical pilot/feasibility questions and signals from clinical outcomes to inform a future definitive trial. PATIENTS AND METHODS The study design piloted was a blinded surgical RCT. All participants underwent unilateral ND for head and neck cancer. Interventional arm: ND with application of FS. CONTROL ARM ND alone. Feasibility outcomes included recruitment, effectiveness of blinding, protocol adherence and evaluating administrative processes. Clinical outcomes included surgical complications (primary outcome), drainage volume, time to drain removal, length of hospital stay, pain and the Neck Dissection Impairment Index. RESULTS Recruitment completed ahead of time. Fifty-three patients were recruited, and 48 were randomised at a rate of 5.3 patients/month. Blinding of patients, research nurses and outcome assessors was effective. Two protocol deviations occurred. Two patients were lost to follow-up. The mean (SD) Comprehensive Complication Index in the interventional arm was 6.5 (12.8), and it was 9.9 (14.2) in the control arm. The median (IQR) time to drain removal (days) was shorter in the interventional arm (2.67 (2.42, 3.58) vs. 3.40 (2.50, 4.27)). However, this did not translate to a clinically significant reduction in median (IQR) length of hospital stay in days (intervention: 3.48 (2.64, 4.54), control: 3.74 (3.11, 4.62)). CONCLUSION The proposed trial design was effective, and a definitive surgical trial is feasible. Whilst there was a tendency for FS to improve clinical outcomes, the effect size did not reach clinical or statistical significance. (ISRCTN99181100).
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Affiliation(s)
- Mandeep S. Bajwa
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool L69 3BX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
| | - Richard Jackson
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool L69 3BX, UK
| | - Jagtar Dhanda
- Head & Neck Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK
| | - Catrin Tudur Smith
- Institute of Population Health, The University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool L69 3GF, UK
| | - Richard J. Shaw
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
| | - Andrew G. Schache
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
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Golder H, Casanova D, Papalois V. Evaluation of the usefulness of the Clavien-Dindo classification of surgical complications. Cir Esp 2023; 101:637-642. [PMID: 36781046 DOI: 10.1016/j.cireng.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/13/2023]
Abstract
The Clavien-Dindo (CD) classification is widely used in the reporting of surgical complications in scientific literature. It groups complications based on the level of intervention required to resolve them, and benefits from simplicity and ease of use, both of which contribute its to high inter-rater reliability. It has been validated for use in many specialties due to strong correlation with key outcome measures including length of stay, postsurgical quality of life and case-related renumeration. Limitations of the classification include concerns over differentiating grade III and IV complications and not classifying intraoperative complications. The Comprehensive Complication Index is an adaptation of the CD classification which generates a morbidity score from 0 to 100. It has been proposed as a more effective method of assessing the morbidity burden of surgical procedures. However, it remains less popular as calculations of morbidity are complicated and time-consuming. In recent years there have been suggestions of adaptations to the CD classification such as the Clavien-Dindo-Sink classification, while in some specialties, completely new classifications have been proposed due to evidence the CD classification is not reliable. Similarly, the Surgical Expertise and Validity Evaluation project aims to determine benchmarks against which surgeons may compare their own practice.
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7
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Haga Y, Yasunaga Y, Araki J, Nakao J, Mori H, Nakagawa M, Mukaigawa T. Perioperative Factors Aggravating Pharyngocutaneous Fistula After Total Laryngectomy: A Single-Center Retrospective Analysis Using the Clavien-Dindo Classification. Ann Plast Surg 2023; 91:84-89. [PMID: 37450865 DOI: 10.1097/sap.0000000000003627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Pharyngocutaneous fistula formation represents a major postoperative complication following total laryngectomy. We aimed to investigate the risk factors for pharyngocutaneous fistula development after total laryngectomy and to identify factors that lead to severe cases of pharyngocutaneous fistula. METHODS Patients who underwent total laryngectomy between January 2013 and February 2021 were included in the study and were divided into 2 groups: Those with and without pharyngocutaneous fistula. The severity of pharyngocutaneous fistula was graded using the Clavien-Dindo classification. RESULTS Patients with pharyngocutaneous fistula experienced longer operative time, greater intraoperative blood loss, greater decrease in perioperative hemoglobin level, and longer postoperative hospitalization. Unlike in lower-severity cases, patients with grade IIIb pharyngocutaneous fistula underwent preoperative radiotherapy or chemoradiotherapy; preoperative treatment was thus a risk factor for higher severity of pharyngocutaneous fistula (odds ratio, 35; P = 0.004). CONCLUSION Salvage laryngectomy was found to be a predictor of severe pharyngocutaneous fistula development. Prolonged operative time, increased intraoperative blood loss, and decreased postoperative hemoglobin level were found to be predictors of postlaryngectomy pharyngocutaneous fistula formation.
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Affiliation(s)
| | - Yoshichika Yasunaga
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Jun Araki
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Junichi Nakao
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Hiroaki Mori
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | | | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
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Ronen O, Robbins KT, Shaha AR, Kowalski LP, Mäkitie AA, Florek E, Ferlito A. Emerging Concepts Impacting Head and Neck Cancer Surgery Morbidity. Oncol Ther 2023; 11:1-13. [PMID: 36565427 PMCID: PMC9935772 DOI: 10.1007/s40487-022-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
All treatment modalities for head and neck cancer carry with them a risk of adverse events. Head and neck surgeons are faced with significant challenges to minimize associated morbidity and manage its sequelae. Recognizing situations in which a surgical complication is an adverse event inherent to the procedure can alleviate the psychologic impact a complication might have on the treatment team and minimize external and internal pressures. Focusing on the complications that can be effectively modified, future complications can be avoided. Also, some surgical morbidities may not be preventable, necessitating the option to reconsider whether the incidents should be labeled toxic reactions rather than a complication. This discussion highlights some of the areas in which additional research is needed to achieve the goal of minimizing the impact of surgical morbidity.
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Affiliation(s)
- Ohad Ronen
- Head and Neck Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Affiliated With Azrieli Faculty of Medicine, Galilee Medical Center, Bar-Ilan University, POB 21, Nahariya, Safed, 2210001, Israel.
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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9
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Li D, Niu Q, Wang C, Wei W, Li B, Liu H, Xiao R, Wang H, Xu Q, Han Z, Feng Z. Comprehensive complication index: A new reporting standard for postoperative complications of free-flap reconstruction in head and neck cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:33-41. [PMID: 35985962 DOI: 10.1016/j.oooo.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/12/2022] [Accepted: 05/13/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We aimed to validate and evaluate the comprehensive complication index (CCI) as a measure of postoperative complications (POCs) in the patients with head and neck squamous cell carcinoma (HNSCC) who had undergone free-flap reconstruction. STUDY DESIGN A single-center, prospective cohort study was conducted on the patients with primary HNSCC treated between 2015 and 2020. RESULTS Of 443 patients, 177 experienced POCs (40.0%). According to the new CCI, 93 patients had severe POCs (score ≥26.2; 21.0%), and only 76 patients were classified as having severe POCs (grade ≥III; 17.2%) according to the traditional Clavien-Dindo classification (CDC). The patients with CCI scores ≥26.2 had a higher rate of major adverse short-term outcomes, such as prolonged length of the hospital stay after surgery, excessive medical costs, and the need for transfusion. Importantly, the Kaplan-Meier analysis revealed a lower overall survival rate for patients with severe complications (CCI score ≥26.2, P = .038). However, no statistically significant differences were observed between CDC grades III or above and overall survival (P = .100). CONCLUSIONS The CCI can be used to evaluate POCs of free-flap reconstruction in patients with HNSCC. It performed more accurately than the CDC in short- and long-term outcome prediction and risk factor identification.
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Affiliation(s)
- Delong Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Qifang Niu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chong Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Huan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Ranran Xiao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Qiaoshi Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
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Henneman R, Rouwenhorst L, Karakullukcu MB, Smeele LE, Lohuis PF, van den Brekel MW, Hamming-Vrieze O, Jóźwiak K, Balm AJ. Surgical site complications of isolated salvage neck dissection post-radiotherapy and post-chemoradiotherapy - A cohort analysis (1997-2017). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:764-770. [PMID: 36586789 DOI: 10.1016/j.ejso.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION This study aims to quantify surgical site complications (SSC) after isolated salvage neck dissection (ND) compared with primary ND. PATIENTS AND METHODS Between 1997 and 2017 in the Netherlands Cancer Institute - Antoni van Leeuwenhoek, a total of 323 isolated NDs were performed in 308 patients: primary ND (n = 144), post-radiotherapy (RT) ND (n = 53) and post-chemoradiotherapy (CRT) ND (n = 126). Patient, tumor and therapy characteristics were recorded. SSCs were scored according to the Clavien-Dindo Classification (CDC). RESULTS 101 NDs (31%) were complicated by at least one SSC. In total, 189 different SSCs occurred. Translated to CDC, 45 complications were grade 2, 25 grade 3a and 31 grade 3b. No significant difference in occurrence of SSC (CDC >1) was found between all groups. However, post-CRT, selective (SND) and modified radical ND and radical ND (MRND/RND) (p = 0.005), resection of sternocleidomastoid muscle (SCM) (p = 0.039) and duration of super selective ND surgery (p = 0.048) were significantly associated with more SSC. SCM muscle removal was associated with more surgical site infection (p = 0.045) and necrosis (p = 0.036). From week 10 post-RT/CRT, no difference in complication frequency with primary ND was seen. CONCLUSION Post-CRT SND, MRND/RND and SCM muscle resection were associated with an increased incidence of SSCs. If oncologically possible, limit the extent of ND and when an MRND is inevitable, preserve the SCM muscle for optimal prevention of SSC. Concerning SSC, optimal timing of salvage ND is minimal 10 weeks after RT/CRT.
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Affiliation(s)
- Roel Henneman
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - Linda Rouwenhorst
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Baris Karakullukcu
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ludwig E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands; Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, the Netherlands
| | - Peter Fjm Lohuis
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michiel Wm van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Alfons Jm Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands
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11
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Wang Y, Zhou B, Chen WL, Huang ZX, Chen R. Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma. Head Face Med 2022; 18:39. [PMID: 36471377 PMCID: PMC9720977 DOI: 10.1186/s13005-022-00343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND This study evaluated the outcomes of facial-submental artery island flap (FSAIF) for reconstruction of the hemitongue following cancer ablation in patients with early and middle-stage oral tongue squamous cell carcinoma (OTSCC). METHODS In total, 122 patients with early and middle-stage OTSCC were divided into young, middle-aged, and elderly groups. The Adult Comorbidity Evaluation-27 (ACE-27) index was used to determine the presence of comorbidities. The patients underwent surgical treatment with hemiglossectomy, neck dissection, and hemitongue reconstruction using FSAIF. In addition, stage I (n = 15) and II (n = 69) patients underwent ipsilateral selective neck dissection, whereas those with stage III (n = 38) underwent radical neck dissection. Six patients with T3N1 disease also underwent cobalt-60 adjuvant radiotherapy. RESULTS Young and elderly patients exhibited significant differences in comorbidities, as assessed by the ACE-27 (p < .05). The skin paddles in the young, middle-aged, and elderly patients were 3 × 9 to 4 × 12 cm, 3 × 11 to 4 × 12, and 3 × 10 to 5 × 13 cm in size, respectively. FSAIF failure occurred in four patients (success rate: 96.7%). No significant differences were observed in the skin paddle of the flap or rate of flap failure among the age groups (p > .05). Clavien-Dindo grades I, II, IIIa, IIIb, Iva, and IVb were assigned to 7.1, 36.1, 38.5, 9.8, 4.1, and 4.1% of the patients, respectively, with significant differences seen between the young and elderly patients (p < .05). In total, 52.5% of patients could eat normally, whereas 32.8% required a soft diet. Furthermore, 53.3 and 33.6% of patients achieved normal and intelligible speech, respectively. The aesthetic results were rated as excellent and good in 32.8 and 58.2% of patients, respectively. In total, 68.0% of the patients were alive and exhibited no evidence of disease, while 19.7% were alive with active disease. In addition, 12.3% of patients with stage III OTSCC died due to local recurrence or distant metastases. No differences in swallowing, speech, aesthetic, or survival outcomes were observed among the groups. CONCLUSIONS FSAIF is a simple, safe, and reliable method for reconstructing hemitongue defects following cancer ablation in young, middle-aged, and elderly patients with early and middle-stage OTSCC.
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Affiliation(s)
- Yan Wang
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Bin Zhou
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Wei-liang Chen
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Zi-xian Huang
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Rui Chen
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
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12
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Patterns of neck metastasis and occult neck disease during recurrent laryngeal cancer. J Laryngol Otol 2022; 137:570-576. [PMID: 35871798 DOI: 10.1017/s0022215122001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Numerous factors are considered to impact on the rate of complications during salvage total laryngectomy procedures. Neck dissection could be one of these factors. This study analysed the pattern of lymph node metastasis and rate of occult neck disease during salvage total laryngectomy as well as the impact of neck dissection on survival and complication rates. METHOD This was a retrospective analysis of a prospectively maintained laryngectomy database in two large tertiary teaching hospitals. RESULTS The rate of occult neck disease was 11.1 per cent. Most cases with occult neck disease had rT4 disease. Patients with complications, advanced tumour stage and positive margins had a significant decrease in overall survival. Patients receiving elective neck dissection did not have any survival benefit. Positron emission tomography-computed tomography showed a very high specificity and negative predictive value. CONCLUSION According to the low risk of occult neck disease when using contemporary imaging techniques as well as the lack of impact on survival, conservative management of the neck should be considered for crT1-T3 recurrence.
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13
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Benoiton LA, MacLachlan AL, Mustard J, Jayawardana J, Bird P. Classification of cochlear implant complications using a modified Clavien-Dindo classification. Cochlear Implants Int 2022; 23:317-325. [PMID: 35818635 DOI: 10.1080/14670100.2022.2096193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Cochlear implantation (CI) surgery is a highly effective procedure for severe to profound hearing loss, with a low complication rate. There are currently multiple grading systems for CI surgery complications, making comparison of outcomes difficult. We propose a modification to the Clavien-Dindo classification of complications, and use this modified classification to analyse our complications. METHODS Complications were classified as: I - Self-limiting complications requiring no treatment or simple pharmacological therapies; II - Complications requiring pharmacological interventions other than those permitted under the criteria for Grade I, or non-invasive radiological imaging; IIIa - Complications necessitating surgical, radiological or endoscopic intervention, but excluding implant explantation and/or reimplantation. IIIb - Complications necessitating implant explantation and/or reimplantation. RESULTS 1053 patients were recorded as having had at least one cochlear implant inserted with 114 complications reported in 90 patients. The 114 complications were classified into the proposed classification with 18 (15.7%) as Grade I, 36 (31.5%) as Grade II, 17 (14.9%) as Grade IIIa and 43 (34.2%) as Grade IIIb. DISCUSSION We found a low complication rate, and were able to use the modified Clavien-Dindo classification system to analyse our data. We would strongly advocate for a uniform reporting system and propose this modification of a widely used system.
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Affiliation(s)
- Lara Angele Benoiton
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | | | - Jill Mustard
- Southern Cochlear Implant Programme, Christchurch, New Zealand
| | - Janitha Jayawardana
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Philip Bird
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand.,Southern Cochlear Implant Programme, Christchurch, New Zealand
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14
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Abolfotouh S, Bäck L, Aro K, Lassus P, Vuola J, Mesimäki K, Wilkman T, Vikatmaa P. Carotid interposition in patients with head and neck tumors: clinical experience of 13 cases reconstructed with a great saphenous vein autograft. Acta Otolaryngol 2022; 142:419-424. [PMID: 35499961 DOI: 10.1080/00016489.2022.2067356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Carotid interposition graft (CIG) surgery in the setting of head & neck cancer (HNC) is a rare procedure with a limited number of cases described in the literature. AIMS/OBJECTIVES To assess the outcomes of the surgery at Helsinki University Hospital. MATERIALS AND METHODS Patients who underwent CIG in a head and neck tumor surgery were retrospectively analyzed over 15 years. Overall-survival (OS) was calculated until 1 May 2020. The primary-outcome was to measure the 30-day OS, postoperative stroke rate, and other complications. The secondary-outcome was to measure 1-, 2-, and 5-year OS. RESULTS Thirteen patients were identified, 11 with HNC and two with Shamblin III Carotid Body Tumors. The great saphenous vein was used for all vascular reconstructions, and shunting was routinely performed. The 30-day stroke incidence was nil. Two graft-blowouts were encountered, one of which lead to death and the other was successfully managed. For HNC patients, the locoregional recurrence-rate was 36%. The 5-year OS was 46.2%. CONCLUSION AND SIGNIFICANCE CIG in HNC setting can achieve oncologic-control with an acceptable rate of complications. Routine shunting, heparinization, and elevating blood-pressure during closure seem to be safe protocols to maintain cerebral-circulation perioperatively. A moderate graft-blowout risk should be considered.
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Affiliation(s)
- Sherif Abolfotouh
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jyrki Vuola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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15
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von der Grün J, Winkelmann R, Burck I, Martin D, Rödel F, Wild PJ, Bankov K, Weigert A, Kur IM, Brandts C, Filmann N, Issing C, Thönissen P, Tanneberger AM, Rödel C, Ghanaati S, Balermpas P. Neoadjuvant Chemoradiotherapy for Oral Cavity Cancer: Predictive Factors for Response and Interim Analysis of the Prospective INVERT-Trial. Front Oncol 2022; 12:817692. [PMID: 35402268 PMCID: PMC8988145 DOI: 10.3389/fonc.2022.817692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
BackgroundTo study neoadjuvant chemoradiotherapy (nCRT) and potential predictive factors for response in locally advanced oral cavity cancer (LA-OCC).MethodsThe INVERT trial is an ongoing single-center, prospective phase 2, proof-of-principle trial. Operable patients with stage III-IVA squamous cell carcinomas of the oral cavity were eligible and received nCRT consisting of 60 Gy with concomitant cisplatin and 5-fluorouracil. Surgery was scheduled 6-8 weeks after completion of nCRT. Explorative, multiplex immunohistochemistry (IHC) was performed on pretreatment tumor specimen, and diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted prior to, during nCRT (day 15), and before surgery to identify potential predictive biomarkers and imaging features. Primary endpoint was the pathological complete response (pCR) rate.ResultsSeventeen patients with stage IVA OCC were included in this interim analysis. All patients completed nCRT. One patient died from pneumonia 10 weeks after nCRT before surgery. Complete tumor resection (R0) was achieved in 16/17 patients, of whom 7 (41%, 95% CI: 18-67%) showed pCR. According to the Clavien-Dindo classification, grade 3a and 3b complications were found in 4 (25%) and 5 (31%) patients, respectively; grade 4-5 complications did not occur. Increased changes in the apparent diffusion coefficient signal intensities between MRI at day 15 of nCRT and before surgery were associated with better response (p=0.022). Higher abundances of programmed cell death protein 1 (PD1) positive cytotoxic T-cells (p=0.012), PD1+ macrophages (p=0.046), and cancer-associated fibroblasts (CAFs, p=0.036) were associated with incomplete response to nCRT.ConclusionnCRT for LA-OCC followed by radical surgery is feasible and shows high response rates. Larger patient cohorts from randomized trials are needed to further investigate nCRT and predictive biomarkers such as changes in DW-MRI signal intensities, tumor infiltrating immune cells, and CAFs.
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Affiliation(s)
- Jens von der Grün
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- *Correspondence: Jens von der Grün,
| | - Ria Winkelmann
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Daniel Martin
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Peter Johannes Wild
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Katrin Bankov
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ivan-Maximiliano Kur
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Brandts
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Medicine, Hematology/Oncology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Issing
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Philipp Thönissen
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Anna Maria Tanneberger
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Shahram Ghanaati
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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16
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Guissé NF, Stone JD, Keil LG, Bastrom TP, Erickson MA, Yaszay B, Cahill PJ, Parent S, Gabos PG, Newton PO, Glotzbecker MP, Kelly MP, Pahys JM, Fletcher ND. Modified Clavien-Dindo-sink classification system for adolescent idiopathic scoliosis. Spine Deform 2022; 10:87-95. [PMID: 34351605 DOI: 10.1007/s43390-021-00394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The Clavien-Dindosink (CDS) classification system provides more treatment-focused granularity than subjective methods of describing surgical complications; however, it has not been validated in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The purpose of this study was to modify the CDS system for application in patients with AIS undergoing PSF to assess its inter- and intra-rater reliability for describing complications faced by this population. METHODS A review of all complications specific to patients with AIS captured in a large multicenter international database was performed. All complications were classified according to CDS, modified by addition of "prolonged initial hospital stay" as a criterion for Grade II. A survey of this complication list and an additional 20 clinical vignettes (sent out on two occasions) was sent to nine spinal deformity surgeons. Weighted kappa values were used to determine inter- and intra-rater reliability. RESULTS The Fleiss κ value for interrater reliability among 5 respondents grading all AIS complications was 0.8 (very good). For each grade, interrater reliability was very good, with an overall range of 0.8-1. The overall kappa value for intrarater reliability among eight respondents grading 20 vignettes was between 0.6 (good) and 0.9 (very good). CONCLUSION The modified CDS classification system has very good interrater and intrarater reliability in describing complications following PSF in patients with AIS. This system may be of greater utility for reporting outcomes than a "major" versus "minor" complication system and can serve as a valuable tool for improving surgical practices and patient outcomes in this population. LEVEL OF EVIDENCE IV case series.
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Affiliation(s)
- Ndéye F Guissé
- Department of Orthopaedics, Washington University, St. Louis, MO, USA
| | - Joseph D Stone
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Lukas G Keil
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Tracey P Bastrom
- Department of Orthopaedic Surgery, Children' Healthcare of Atlanta, 1400 Tullie Road, Atlanta, GA, 30329, USA
| | - Mark A Erickson
- Department of Orthopaedic Surgery, University of Colorado, Boulder, CO, USA
| | - Burt Yaszay
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan Parent
- Department of Orthopaedic Surgery, University of Montreal, Montreal, Canada
| | - Peter G Gabos
- Department of Orthopaedic Surgery, Afred I. DuPont Institute, Wilmington, DE, USA
| | - Peter O Newton
- Department of Orthopedics Surgery, UC San Diego School of Medicine, San Diego, CA, USA
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, University Hospitals Rainbow Babies Hospital, Cleveland, OH, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Joshua M Pahys
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Nicholas D Fletcher
- Department of Orthopaedic Surgery, Children' Healthcare of Atlanta, 1400 Tullie Road, Atlanta, GA, 30329, USA.
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17
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Mascarella MA, Gardiner L, Patel T, Vendra V, Khan N, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Sridharan SS. Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction. Microsurgery 2021; 42:209-216. [PMID: 34935198 DOI: 10.1002/micr.30848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Sarcopenia is increasingly being recognized as a negative prognostic factor in patients with head and neck cancer (HNC). We associate a sarcopenia biomarker measured radiographically from computed tomography (CT) of the neck to postoperative adverse events in patients with operable HNC. PATIENTS AND METHODS A prospective cohort of treatment-naïve HNC patients undergoing surgery with microvascular reconstruction was performed. Cervical paraspinal skeletal muscle index (CPSMI) was calculated using preoperative CT neck imaging and adjusted for height and sex. Postoperative adverse events, including Clavien-Dindo Grade 3+ complications and fistula, were recorded within 30-days of the index surgery. Multivariate logistic regression was used to evaluate the association between CPSMI and postoperative complications. The modified frailty index (mFI) and Risk Assessment Index (RAI) were compared with CPSMI outcomes. RESULTS A total of 127 patients with mucosal HNC were included in the study. The mean age was 60.5 years, and 87 (68.5%) patients were male. Sixty Clavien-Dindo grade 3+ events occurred; 17 patients developed an oro/pharyngocutaneous fistula. Low CPSMI was independently associated with Clavien-Dindo Grade 3+ events (OR 2.80, 95% CI of 1.18-6.99) and fistula (OR of 6.10, 95% CI of 1.53-24.3) when adjusted for multiple factors. CPSMI outperformed the mFI and RAI frailty indices to predict postoperative adverse events (p < .05). CONCLUSION Low CPSMI is independently associated with postoperative adverse events and outperforms current frailty indices inoperable HNC with microvascular reconstruction.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Lauren Gardiner
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Terral Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nayel Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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18
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Hostetter J, Yazbek S. Postoperative Pharynx and Larynx. Neuroimaging Clin N Am 2021; 32:37-53. [PMID: 34809843 DOI: 10.1016/j.nic.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cancers of the pharynx and larynx are treated using a combination of chemotherapeutic, radiation, and surgical techniques, depending on the cancer type, biology, location, and stage, as well as patient and other factors. When imaging in the postsurgical setting, the knowledge of the type of tumor, preoperative appearance, and type of surgery performed is essential for accurate interpretation. Surgical anatomic changes, surgical implants/devices, and potential postsurgical complications must be differentiated from suspected recurrent tumors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA.
| | - Sandrine Yazbek
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA
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19
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Sebök M, Blum P, Sarnthein J, Fierstra J, Germans MR, Serra C, Krayenbühl N, Regli L, Esposito G. Validation of the Clavien-Dindo grading system of complications for microsurgical treatment of unruptured intracranial aneurysms. Neurosurg Focus 2021; 51:E10. [PMID: 34724644 DOI: 10.3171/2021.8.focus20892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Microsurgery plays an essential role in managing unruptured intracranial aneurysms (UIAs). The Clavien-Dindo classification is a therapy-oriented grading system that rates any deviation from the normal postoperative course in five grades. In this study, the authors aimed to test the applicability of the Clavien-Dindo grade (CDG) in patients who underwent microsurgical treatment of UIAs. METHODS The records of patients who underwent microsurgery for UIAs (January 2013-November 2018) were retrieved from a prospective database. Complications at discharge and at short-term follow-up (3 months) were rated according to the Clavien-Dindo system. Patient outcomes were graded using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). A descriptive statistic was used for data analysis. RESULTS Overall, 156 patients underwent 157 surgeries for 201 UIAs (size range 4-42 mm). Thirty-nine patients (25%) had complex UIAs. An adverse event (CDG ≥ I) occurred in 21 patients (13.5%) by the time of discharge. Among these, 10 patients (6.4%) presented with a new neurological deficit. Significant correlations existed between a CDG ≥ I and an increase in mRS and NIHSS scores (p < 0.001). Patients treated for complex aneurysms had a significantly higher risk of developing new neurological deficits (20.5% vs 1.7%, p = 0.007). At the 3-month follow-up, a CDG ≥ I was registered in 16 patients (10.3%); none presented with a new neurological deficit. A CDG ≥ I was associated with a longer hospital length of stay (LOS) (no complication vs CDG ≥ I, 6.2 ± 3.5 days vs 9.3 ± 7.7 days, p = 0.02). CONCLUSIONS The CDG was applicable to patients who received microsurgery of UIAs. A significant correlation existed between CDG and outcome scales, as well as LOS. The aneurysm complexity was significantly associated with a higher risk for new neurological deficit.
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Affiliation(s)
- Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Patricia Blum
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Carlo Serra
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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20
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Katna R, Girkar F, Tarafdar D, Bhosale B, Singh S, Agarwal S, Deshpande A, Kalyani N. Pedicled Flap vs. Free Flap Reconstruction in Head and Neck Cancers: Clinical Outcome Analysis from a Single Surgical Team. Indian J Surg Oncol 2021; 12:472-476. [PMID: 34658573 DOI: 10.1007/s13193-021-01353-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Head and neck cancers are one of the leading causes of morbidity and mortality in Indian population. Reconstruction and restoration of function are also of paramount importance in these patients. The aim of this study was to report outcomes for free flaps and pedicle flaps in patients with oral cavity cancers. A retrospective analysis of 628 patients with oral cavity cancers who underwent reconstruction with either free flaps or pedicle flaps during 2014-2020 was done. The median age of the cohort was 49 years. The free flap reconstruction was performed in 481 (76%) and pedicle flap in 147 (24%) patients. Among free and pedicle flaps, 27 (5.6%) and 3 (2.1%) respectively had major flap complications and 25 (5.1%) and 14 (9.9%) respectively had minor complications. CCI score > 4 was associated with higher events (p = 0.02) in free flap group. The outcomes of free flaps are similar in comparison to pedicle flaps in patients with oral cavity cancers. The higher CCI score is significantly associated with increased flap-related complications for the free flap group.
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Affiliation(s)
- Rakesh Katna
- Department of Oncology, Jaslok Hospital and Research Centre, Pedder Road, Mumbai, 400026 India.,Bombay Hospital and Research Centre, Marine Lines, Mumbai, India.,Vedant Hospital, Thane, India
| | | | | | - Bharat Bhosale
- Department of Oncology, Jaslok Hospital and Research Centre, Pedder Road, Mumbai, 400026 India.,Bombay Hospital and Research Centre, Marine Lines, Mumbai, India.,Vedant Hospital, Thane, India
| | | | - Suyash Agarwal
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, India
| | - Akshay Deshpande
- Department of Oncology, Jaslok Hospital and Research Centre, Pedder Road, Mumbai, 400026 India.,Bombay Hospital and Research Centre, Marine Lines, Mumbai, India
| | - Nikhil Kalyani
- Department of Oncology, Jaslok Hospital and Research Centre, Pedder Road, Mumbai, 400026 India
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21
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Bonitz L, Wruck V, Peretti E, Abel D, Hassfeld S, Bicsák Á. Long-term evaluation of treatment protocols for isolated midfacial fractures in a German nation-wide craniomaxillofacial trauma center 2007-2017. Sci Rep 2021; 11:18291. [PMID: 34521960 PMCID: PMC8440643 DOI: 10.1038/s41598-021-97858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
An update on the trends in maxillofacial traumatology provides additional information on the actual and changing needs. This retrospective study aimed to review all patient records of patients treated for isolated midface fractures in the Department of Cranial- and Maxillofacial Surgery at the Dortmund General Hospital between 2007 and 2017. The patient radiographs and patient files were reviewed. The safety and efficacy of the applied methods were controlled by assessing complications based on the Clavien-Dindo classification system. The statistical analysis included descriptive methods including regression analysis and χ2-test. In eleven years, 3474 isolated midface fracture sites have been identified in 2868 patients. The yearly trend is slightly increasing, in elderly clearly worsening, in children and youth decreasing. The male-to-female ratio was 2.16:1 for the whole study population, in the age group 18-25 y.o. 6.95:1 while in elderly above 80 y.o. 1:2.51, the age group specific incidence reflects this result, too. The most common fractures were nasal bone fractures (1405), zygomatic fractures (832) and orbital floor fractures (700). The average hospital stay was 2.7 days, the most fractures were operated within 24 h. The complication rate was 2.02% (Clavien-Dindo class II-V). The incidence of midfacial fractures is increasing in the total population and especially in elderly, but decreasing in children. Development of injury prevention measures is needed in this population. The diagnostic and therapeutic procedures are appropriate, as there is a low complication rate and short inpatient stay observed.
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Affiliation(s)
- Lars Bonitz
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Vivienne Wruck
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Elena Peretti
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Dietmar Abel
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Stefan Hassfeld
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Ákos Bicsák
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany.
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany.
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22
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Panda S, Vig S, Singh CA, Konkimalla A, Thakar A, Sakthivel P, Sikka K, Kumar R, Bhatnagar S, Mohan A, Tiwari P, Meena VP, Garg RK, Bollu S, Thakur K. Head and Neck Surgery During COVID-19 Pandemic: Experience from a Tertiary Care in India. Indian J Surg Oncol 2021; 12:279-289. [PMID: 34539130 PMCID: PMC8435157 DOI: 10.1007/s13193-021-01424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020. One hundred procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-19-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien-Dindo grading for postoperative complications was as follows: 1–4, 2–12, 3a-2, 3b-1. Eleven patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID-19 designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID-19 ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. A matched-pair analysis was performed with similarly staged historical cohort operated during January to December 2016 to compare peri-operative complication rates (Clavien-Dindo Score). Incidence of complication with higher Clavien Dindo Score (>/=3a) was found to be lower in those patients operated during the pandemic (p=0.007). By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without jeopardising the risk of transmission of COVID-19 to the patients or health-care workers.
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Affiliation(s)
- Smriti Panda
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Abhilash Konkimalla
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Pirabu Sakthivel
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pavan Tiwari
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit K. Garg
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumanth Bollu
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Kuldeep Thakur
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
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23
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Orzell S, Verhaaren BFJ, Grewal R, Sklar M, Irish JC, Gilbert R, Brown D, Gullane P, de Almeida JR, Yu E, Su J, Xu W, Alibhai SMH, Goldstein DP. Evaluation of Sarcopenia in Older Patients Undergoing Head and Neck Cancer Surgery. Laryngoscope 2021; 132:356-363. [PMID: 34383321 DOI: 10.1002/lary.29782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS Sarcopenia is a hallmark of aging and its identification may help predict adverse postoperative events in patients undergoing head and neck surgery. The study objective was to assess the relationship between sarcopenia and postoperative complications and length of stay in patients undergoing major head and neck cancer surgery. STUDY DESIGN Prospective cohort study. METHODS A prospective cohort study was performed of patients 50 years and older undergoing major head and neck surgery. Sarcopenia was defined as low muscle mass (determined by neck muscle cross-sectional imaging) with either low muscle strength (grip strength) or low muscle performance (timed walk test). Logistic regression was applied on binary outcomes, and linear regression was used for log-transformed length of hospital stay (LOS). Univariate and multivariate analyses were performed. RESULTS Of the 251 patients enrolled, pre-sarcopenia was present in 34.9% (n = 87) and sarcopenia in 15.6% (n = 39) of patients. Patients with sarcopenia were more likely to be older (P = .001), female (P = .001), have a lower body mass index (P = .001), and lower preoperative hemoglobin (P < .001). On univariate analysis, the presence and severity of sarcopenia was associated with the development of medical complications (P = .029), higher grade of complications (P = .032), LOS (P = .015), and overall survival (P = .001). On multivariate analysis, sarcopenia was associated with a longer LOS (β = 0.32 [95% CI: 0.19-0.45], P < .001) and worse overall survival (HR = 2.21 [95% CI: 1.01-4.23], P = .017). CONCLUSIONS Sarcopenia may aid in the prediction of prolonged hospital stay and death in patients who are candidates for major head and neck surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Susannah Orzell
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | | | - Rajan Grewal
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Michael Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Dale Brown
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
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24
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Classifying the causes of morbidity and error following treatment of facial fractures. Br J Oral Maxillofac Surg 2021; 60:308-312. [PMID: 34753656 DOI: 10.1016/j.bjoms.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022]
Abstract
Analysing morbidity and using this to improve the quality of patient care is an important component of clinical governance. Several methods of data collection and clinical analysis have been suggested, but to date none have been widely adopted. All adult patients sustaining facial fractures were prospectively identified between 01 March 2019 and 28 February 2020, and matched to those who required a return to theatre for surgical complications. Morbidity resulting in a return to theatre was determined using the Clavien-Dindo classification and the Northwestern University error ascribing method. During this period, return to theatre occurred for 33/285 (11.6%) procedures and 23/173 (13.3%) of patients being treated for facial fractures. According to the 27 procedures discussed, Clavien-Dindo Grade IIIb was most commonly found (20/27). Error in judgement (13/35) and nature of disease (12/35) were ascribed as the most common causes of error. Presence of a consultant was associated with increased odds of a return to theatre (p = 0.014). Standardised national data collection of morbidity and error is required for comparisons of outcomes within a single institution or between institutions. To the best of our knowledge, this is the first paper to utilise these widely used methods of morbidity analysis for facial fracture surgery. We would recommend further development of an error analysis method that is more specific to complications from facial fracture surgery.
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25
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Dodhia S, Fitzgerald CWR, McLean AT, Yuan A, Valero Mayor C, Adilbay D, Mimica X, Gupta P, Cracchiolo JR, Patel S, Wong RJ, Shah J, Ganly I, Cohen MA. Predictors of surgical complications in patients with sinonasal malignancy. J Surg Oncol 2021; 124:731-739. [PMID: 34236707 DOI: 10.1002/jso.26598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Sinonasal and skull base tumors are rare, making it difficult to identify trends in surgical outcome. This study examines complications in a large cohort of patients undergoing surgery for sinonasal malignancy. METHODS Following IRB approval, an institutional database was reviewed to identify patients who underwent surgery for sinonasal or skull base malignancies from 1973 to 2016 at our institution. Charlson comorbidity index score and Clavien-Dindo grade were calculated. The main study endpoint was subgroup analysis of Clavien-Dindo Grade 0, Grades 1-2, and Grades 3-5 complications. An ordinal logistic regression model was constructed to assess the association between comorbidities, demographics, tumor characteristics, and surgical complications. RESULTS In total, 448 patients met inclusion criteria. Perioperative mortality rate at 30 days was 1.6% (n = 7). The rate of severe complications (Clavien-Dindo 3 or higher) was 13.6% (n = 61). Multivariate analysis using an ordinal logistic regression model showed no association between Charlson comorbidity index score and Clavien-Dindo grade of postoperative complication. Advanced T-stage was significantly associated with complications (p = 0.0014; odds ratio: 3.442 [95% confidence interval: 1.615, 7.338]). CONCLUSION Surgery for sinonasal and skull base tumors is safe with a low mortality rate. Advanced T-stage is associated with postoperative complications. These findings have implications for preoperative risk stratification. Key Points Surgery for sinonasal malignancy is safe with a 30 mortality of 1.6% and rate of severe complications of 12.8%. There is no association between patient comorbidity and post operative complication. On multivariate analysis, only advanced T stage was associated with increased rate of surgical complication.
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Affiliation(s)
- Sonam Dodhia
- Department of Otolaryngology, Head and Neck Surgery, New York-Presbyterian Hospital, New York, New York, USA
| | - Conall W R Fitzgerald
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew T McLean
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Avery Yuan
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cristina Valero Mayor
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dauren Adilbay
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ximena Mimica
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Piyush Gupta
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J Wong
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin Shah
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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26
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Bras L, de Vries J, Festen S, Steenbakkers RJHM, Langendijk JA, Witjes MJH, van der Laan BFAM, de Bock GH, Halmos GB. Frailty and restrictions in geriatric domains are associated with surgical complications but not with radiation-induced acute toxicity in head and neck cancer patients: A prospective study. Oral Oncol 2021; 118:105329. [PMID: 34111770 DOI: 10.1016/j.oraloncology.2021.105329] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to evaluate the association between frailty screening and geriatric assessment (GA) on short term adverse events in patients treated for head and neck cancer (HNC) for the first time in a prospective study. MATERIALS AND METHODS Newly diagnosed HNC patients undergoing curative treatment were prospectively included in OncoLifeS, a data biobank. Prior to the start of treatment, frailty was assessed with a GA, Groningen Frailty Indicator (GFI) and Geriatric-8 (G8). The GA included comorbidity (Adult Comorbidity Evaluation - 27), nutritional status (Malnutrition Universal Screening Tool), functional status ((instrumental) Activities of Daily Living), mobility (Timed Up & Go), psychological (Geriatric Depression Scale 15) and cognitive (Mini Mental State Examination) measures. Clinically relevant postoperative complications (Clavien-Dindo ≥ grade 2) and acute radiation-induced toxicity (Common Terminology Criteria for Adverse Events version 4.0 ≥ grade 2) were defined as outcome measures. Univariable and multivariable logistic regression analyses were performed, yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). RESULTS Of the 369 included patients, 259 patients were eligible for analysis. Postoperative complications occurred in 41/148 (27.7%) patients and acute radiation-induced toxicity was present in 86/160 (53.7%) patients. Number of deficit domains of GA (OR = 1.71, 95%CI = 1.14-2.56), GFI (OR = 2.54, 95%CI = 1.02-6.31) and G8 (OR5.59, 95%CI = 2.14-14.60) were associated with postoperative complications, but not with radiation-induced toxicity. CONCLUSION Frailty and restrictions in geriatric domains were associated with postoperative complications, but not with radiation-induced acute toxicity in curatively treated HNC patients. The results of this prospective study further emphasizes the importance of geriatric evaluation, particularly before surgery.
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Affiliation(s)
- Linda Bras
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Julius de Vries
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
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27
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Katna R, Singh S, Bhosale B, Deshpande A, Kalyani N. Microvascular reconstruction for head and neck cancers in high risk population: clinical outcomes and complications. Ann R Coll Surg Engl 2021; 103:278-281. [PMID: 33682450 DOI: 10.1308/rcsann.2020.7078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - S Singh
- Vedant Hospital, Thane, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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28
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Foster MT, Hennigan D, Grayston R, van Baarsen K, Sunderland G, Millward CP, Lalgudi Srinivasan H, Ferguson D, Totimeh T, Pizer B, Mallucci C. Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient? J Neurosurg Pediatr 2021; 27:556-565. [PMID: 33636703 DOI: 10.3171/2020.9.peds20556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complications in pediatric neurooncology surgery are seldom and inconsistently reported. This study quantifies surgical morbidity after pediatric brain tumor surgery from the last decade in a single center, using existing morbidity and outcome measures. METHODS The authors identified all pediatric patients undergoing surgery for an intracranial tumor in a single tertiary pediatric neurosurgery center between January 2008 and December 2018. Complications between postoperative days 0 and 30 that had been recorded prospectively were graded using appropriate existing morbidity scales, i.e., the Clavien-Dindo (CD), Landriel, and Drake scales. The result of surgery with respect to the predetermined surgical aim was also recorded. RESULTS There were 477 cases (364 craniotomies and 113 biopsies) performed on 335 patients (188 males, median age 9 years). The overall 30-day mortality rate was 1.26% (n = 6), and no deaths were a direct result of surgical complication. Morbidity on the CD scale was 0 in 55.14%, 1 in 10.69%, 2 in 18.66%, 3A in 1.47%, 3B in 11.74%, and 4 in 1.05% of cases. Morbidity using the Drake classification was observed in 139 cases (29.14%). Neurological deficit that remained at 30 days was noted in 8.39%; 78% of the returns to the operative theater were for CSF diversion. CONCLUSIONS To the authors' knowledge, this is the largest series presenting outcomes and morbidity from pediatric brain tumor surgery. The mortality rate and morbidity on the Drake classification were comparable to those of published series. An improved tool to quantify morbidity from pediatric neurooncology surgery is necessary.
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Affiliation(s)
- Mitchell T Foster
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,2Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool.,3Cancer Research UK Brain Tumour Centre of Excellence, The University of Edinburgh
| | - Dawn Hennigan
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Rebecca Grayston
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Kirsten van Baarsen
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Geraint Sunderland
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,2Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool
| | - Christopher Paul Millward
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,2Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool
| | | | - Deborah Ferguson
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,4Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester; and
| | - Teddy Totimeh
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Barry Pizer
- 5Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Conor Mallucci
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
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Morand GB, Anderegg N, Kleinjung T, Bohlender JE, Veraguth D, Broglie MA, Holzmann D, Huber AM, Röösli C, Soyka MB. Assessment of Surgical Complications With Respect to the Surgical Indication: Proposal for a Novel Index. Front Surg 2021; 8:638057. [PMID: 33681285 PMCID: PMC7930554 DOI: 10.3389/fsurg.2021.638057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: The Clavien–Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. A drawback of the method is that it does not consider why the patient was operated on primarily. Methods: We designed a novel index based on Clavien–Dindo but with respect to the surgical indication. We surveyed an international panel of otolaryngologists who filled out a questionnaire with 32 real case-inspired scenarios. Each case was graded for the surgical complication, surgical indication, and a subjective rating whether the complication was acceptable or not. Results: Seventy-seven otolaryngologists responded to the survey. Mean subjective rating and surgical complication grading for each scenario showed an inverse correlation (r2 = 0.147, p = 0.044). When grading the surgical complication with respect to the surgical indication, the correlation with the subjective rating increased dramatically (r2 = 0.307, p = 0.0022). Conclusion: We describe a novel index grading surgical complications with respect to the surgical indication. In our survey, most respondents judged a complication as acceptable or not according to its grade but kept in mind the surgical indication. This subjective judgment could be quantified with our novel index.
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Affiliation(s)
- Grégoire B Morand
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jörg E Bohlender
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Dorothe Veraguth
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Alexander M Huber
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Grewal R, Sklar MC, de Almeida JR, Xu W, Su J, Thomas CM, Alibhai SM, Goldstein DP. Evaluation of the Braden scale in predicting surgical outcomes in older patients undergoing major head and neck surgery. Laryngoscope Investig Otolaryngol 2021; 6:103-108. [PMID: 33614937 PMCID: PMC7883615 DOI: 10.1002/lio2.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being able to predict negative postoperative outcomes is important for helping select patients for treatment as well for informed decision-making by patients. Frailty measures are often time and resource intensive to use as screening measures, whereas the Braden scale, a commonly used measure to assess patients at risk of developing pressure ulcers after surgery, may be a potential tool to predict postoperative complication rates and longer length of stay (LOS) in patients undergoing major head and neck cancer surgery. METHODS A retrospective analysis of Braden scale scores was performed on a prospectively collected cohort of patients undergoing major head and neck surgery recruited between December 2011 and April 2014. The association of Braden scale score with the primary outcomes of complications and LOS was analyzed using logistic regression and linear regression models on univariate analysis (UVA), respectively. Multivariate analysis (MVA) was performed based on a backward stepwise selection algorithm. RESULTS There were 232 patients with a mean (SD) Braden scale score of 14.9 (2.8) with a range from 9 to 23. The Braden scale (β = -.07 per point; 95% CI -0.09, -0.04, P < .001) was an independent predictor of increased LOS on UVA, but not on MVA when adjusted for other variables. For overall complications, as well as type of complication, the Braden scale score was not a significant predictor of complications on either UVA or MVA. CONCLUSION In the sample population, the Braden scale did not demonstrate an ability to predict negative outcomes in head and neck surgery patients. LEVEL OF EVIDENCE Level 2b individual cohort study.
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Affiliation(s)
- Rajan Grewal
- Department of Otolaryngology Head and Neck Surgery/Surgical OncologyUniversity Health Network, Princess Margaret Cancer Center, University of TorontoTorontoOntarioCanada
| | - Michael C. Sklar
- Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - John R de Almeida
- Department of Otolaryngology Head and Neck Surgery/Surgical OncologyUniversity Health Network, Princess Margaret Cancer Center, University of TorontoTorontoOntarioCanada
| | - Wei Xu
- Department of BiostatisticsPrincess Margaret Cancer Center, University of TorontoTorontoOntarioCanada
| | - Jie Su
- Department of BiostatisticsPrincess Margaret Cancer Center, University of TorontoTorontoOntarioCanada
| | - Carissa M. Thomas
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Shabbir M.H. Alibhai
- Department of MedicineUniversity Health Network, Department of Medicine, University of TorontoTorontoOntarioCanada
| | - David P Goldstein
- Department of Otolaryngology Head and Neck Surgery/Surgical OncologyUniversity Health Network, Princess Margaret Cancer Center, University of TorontoTorontoOntarioCanada
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31
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Locatello LG, Mastronicola R, Cortese S, Beulque E, Salleron J, Gallo O, Dolivet G. Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma. Eur J Surg Oncol 2021; 47:1718-1726. [PMID: 33549376 DOI: 10.1016/j.ejso.2021.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting. MATERIALS AND METHODS The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications. RESULTS With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications. CONCLUSION When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Romina Mastronicola
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
| | - Sophie Cortese
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Emilie Beulque
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Biostatistics Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gilles Dolivet
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
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32
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Maggiore G, Pietragalla M, De Amicis C, Nardi C, Bruno C, Gallo O, Bonasera L, Perrone A, Cavallo A, Colagrande S, Taccetti G, Locatello LG. The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study. Laryngoscope 2021; 131:E2481-E2489. [PMID: 33464574 DOI: 10.1002/lary.29404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/HYPOTHESIS An increasing proportion of adult cystic fibrosis (CF) patients is being referred to endoscopic sinus surgery (ESS) in order to relieve the symptoms of chronic rhinosinusitis (CRS). Given that CFTR mutations profoundly alter sinonasal development, we want to explore the relationship between their peculiar surgical anatomy and the risk of postoperative complications. STUDY DESIGN Retrospective case-control study. METHODS Paranasal sinuses CT scans of 103 CF adult patients with CRS were compared to those belonging to a cohort of 100 non-CF adult patients to explore their anatomical differences. Secondly, CF and non-CF patients who received primary/revision ESS were analyzed in order to assess their preoperative CT scan in terms of surgically relevant variants, and according to the CLOSE checklist. Surgical outcomes were statistically compared in order to explore the differences between groups. RESULTS CF group presented more frequently with smaller and less pneumatized paranasal sinuses and a higher Lund-Mckay score compared with controls. No anatomical differences emerged in terms of genotype stratification. Non-CF CRS patients undergoing ESS showed a significantly deeper olfactory fossa and a more frequent supraorbital pneumatization compared to CF patients (P < .001 and P = .031, respectively). Whereas this latter group underwent more often aggressive surgical procedures (P = .001), no difference in terms of postoperative adverse events was found (P = .620). CONCLUSIONS Despite receiving more often aggressive ESS procedures, adult CF patients do not show an increased risk of postoperative complication and this may be linked to a different proportion of anatomical and surgically-relevant variants. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2481-E2489, 2021.
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Affiliation(s)
| | - Michele Pietragalla
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Christian De Amicis
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Cosimo Nardi
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Luigi Bonasera
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Anna Perrone
- Department of Radiology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Stefano Colagrande
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Giovanni Taccetti
- Cystic Fibrosis Center, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
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Tsai YT, Lai CH, Huang TH, Hsieh CC, Huang EI, Lee YC, Yeh HK, Tsai MS, Chang GH, Hsu CM. Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study. Medicine (Baltimore) 2020; 99:e23860. [PMID: 33350779 PMCID: PMC7769301 DOI: 10.1097/md.0000000000023860] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023] Open
Abstract
Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | - Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | | | | | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung
| | - Hsuan-Keng Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery
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Peroneal flap: How to harvest and clinical appraisal for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:1515-1523. [PMID: 33358676 DOI: 10.1016/j.bjps.2020.11.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 08/26/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A peroneal flap, the boneless version of fibula flap, is considered as the equivalent of radial forearm flap of the lower leg. Because it is thinner than an anterolateral thigh (ALT) flap, the use of a peroneal flap is a viable option for the repair of soft tissue defects when a thin flap could bring about better functional and cosmetic outcomes. In this article, we describe the details of peroneal flap harvest and present our experience with the use of peroneal flaps for head and neck reconstruction. MATERIALS AND METHODS Between 1996 and 2017, a total of 265 peroneal flaps were used to reconstruct a variety of head and neck defects. With the same vascular anatomy and slight modifications to the harvesting technique of a fibula flap, a peroneal flap can be harvested within 1-2 h. All medical records were retrospectively reviewed. RESULTS A peroneal flap can be harvested as different types of chimeric flaps to fit a variety of head and neck defects. The peroneal flap failure rate was 3.4% and the postoperative complication rate was 12.8%. CONCLUSION A peroneal flap might be an alternative option for the reconstruction of head and neck defects.
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Modified Clavien-Dindo Classification and Outcome Prediction in Free Flap Reconstruction among Patients with Head and Neck Cancer. J Clin Med 2020; 9:jcm9113770. [PMID: 33266480 PMCID: PMC7700532 DOI: 10.3390/jcm9113770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/04/2022] Open
Abstract
Because of limitations caused by unique complications of free flap reconstruction, the Clavien–Dindo classification was modified to include grade “IIIc” for “partial or total free flap failure.” From 2013 to 2018, 116 patients who had undergone free flap reconstruction for head and neck cancer with grade III or higher postoperative complications were grouped using the “Modified” Clavien–Dindo classification. Alcoholism displayed significant predictive effects between grade IIIb and IIIc (72.7% vs. 50%, p = 0.028). Significant differences were observed between grade IIIb and IIIc in the duration of hospital stay (23.1 ± 10.1 vs. 28.6 ± 11.9 days, p = 0.015), duration of intensive care unit stay (6.0 ± 3.4 vs. 8.7 ± 4.3 days, p = 0.001), reoperation times during the current hospitalization (1.4 ± 0.8 vs. 2.0 ± 1.0 times, p < 0.001), and wound infection rate (29.9% vs. 62.5%, p = 0.002). The severity levels were significantly positively correlated with reoperation times during the current hospitalization (p < 0.001), ICU stay (p = 0.001), and hospital stay (p < 0.001). The modified Clavien–Dindo classification with grade IIIc describes the perioperative complications of head and neck free flap reconstruction to predict clinical outcomes based on severity.
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Guo MH, Rubens FD. Commentary: Necessity is the Mother of Reinventions. Semin Thorac Cardiovasc Surg 2020; 33:452-453. [PMID: 33181289 DOI: 10.1053/j.semtcvs.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ming Hao Guo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fraser D Rubens
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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37
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Hébert M, Cartier R, Dagenais F, Langlois Y, Coutu M, Noiseux N, El-Hamamsy I, Stevens LM. Standardizing Postoperative Complications-Validating the Clavien-Dindo Complications Classification in Cardiac Surgery. Semin Thorac Cardiovasc Surg 2020; 33:443-451. [PMID: 32979483 DOI: 10.1053/j.semtcvs.2020.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/19/2020] [Indexed: 11/11/2022]
Abstract
Cardiac surgery lacks a method for quantifying postoperative morbidities. The Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) were successfully implemented as outcome reporting methods in other surgical specialties. This study aims to validate these complication scales in cardiac surgery. Between 2010 and 2019, we prospectively collected data on 41,218 adult patients (73% men, mean age 67 ± 11 years) undergoing cardiac surgery at 6 university hospitals. Complications were graded using the CDCC based on the complication's treatment invasiveness with adaptations for common treatments in cardiac surgery. CCI were calculated, representing multiple complications on a scale of 0 (no complication) to 100 (death). Associations with predictors of poor outcome were assessed using mixed-effects models accounting for center as a random effect. CDCC grade was 0 in 23.0%, I in 11.4%, II in 35.3%, IIIa in 6.4%, IIIb in 2.6%, IVa in 16.1%, IVb in 2.1%, and V in 3.1%. Median CCI was 23 (9, 40). A change from lowest to highest observed CDCC grade was associated with an increase in the Society of Thoracic Surgeons mortality score from 1.1% to 4.7%, surgery duration from 177 to 233 minutes, and hospital stay from 5.2 to 17 days (all P < 0.0001). The CCI also increased with greater procedure complexity (P < 0.0001). Increase in CDCC/CCI is associated with greater comorbidities, surgery durations, lengths of stay, and procedure complexity, accurately reflecting the nuances of the adult cardiac surgery postoperative course. These have great potential for uniform outcome reporting and quality improvement initiatives.
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Affiliation(s)
- Mélanie Hébert
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Raymond Cartier
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| | - François Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Québec, Canada
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, Montreal, Canada
| | - Marianne Coutu
- Division of Cardiac Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Nicolas Noiseux
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montreal, Canada
| | - Ismail El-Hamamsy
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada; Division of Cardiac Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Louis-Mathieu Stevens
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montreal, Canada.
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Boukovalas S, Goepfert RP, Smith JM, Mecham E, Liu J, Zafereo ME, Chang EI, Hessel AC, Hanasono MM, Gross ND, Yu P, Lewin JS, Lewis CM, Diaz EM, Weber RS, Myers JN, Offodile AC. Association between postoperative complications and long-term oncologic outcomes following total laryngectomy: 10-year experience at MD Anderson Cancer Center. Cancer 2020; 126:4905-4916. [PMID: 32931057 DOI: 10.1002/cncr.33185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Postoperative complications are an independent predictor of poor survival across several tumors. However, there is limited literature on the association between postoperative morbidity and long-term survival following total laryngectomy (TL) for cancer. METHODS We conducted a retrospective review of all TL patients at a single institution from 2008 to 2013. Demographic and clinical data were collected and analyzed, including postsurgical outcomes, which were classified using the Clavien-Dindo system. Multivariable Cox regression analyses were performed to identify factors associated with overall survival (OS) and disease-free survival (DFS). RESULTS A total of 362 patients were identified. The mean age was 64 years, and the majority of patients were male (81%). The median follow-up interval was 21 months. Fifty-seven percent of patients had received preoperative radiation, and 40% had received preoperative chemotherapy. Fifty-seven percent of patients underwent salvage TL, and 60% underwent advanced reconstruction (45% free flap and 15% pedicled flap). A total of 136 patients (37.6%) developed postoperative complications, 92 (25.4%) of which were major. Multivariable modeling demonstrated that postoperative complications independently predicted shorter OS (hazard ratio [HR], 1.50; 95% CI, 1.16-1.96; P = .002) and DFS (HR, 1.36; 95% CI, 1.05-1.76; P = .021). Other independent negative predictors of OS and DFS included positive lymph node status, preoperative chemotherapy, comorbidity grade, and delayed adjuvant therapy. Severity of complication and reason for TL (salvage vs primary) were not shown to be predictive of OS or DFS. CONCLUSION Postoperative complications are associated with worse long-term OS and DFS relative to uncomplicated cases. Patient optimization and timely management of postoperative complications may play a critical role in long-term survival.
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Affiliation(s)
- Stefanos Boukovalas
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Michael Smith
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, Texas
| | | | - Jun Liu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward I Chang
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew M Hanasono
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peirong Yu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carol M Lewis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Do W, Elzerman T, de Bree R, Rosenberg A, Forouzanfar T, Van Cann EM. Is low or high body mass index in patients operated for oral squamous cell carcinoma associated with the perioperative complication rate? Int J Oral Maxillofac Surg 2020; 50:591-597. [PMID: 32861557 DOI: 10.1016/j.ijom.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 05/25/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to analyse the effect of body mass index (BMI), both low and high values, on the perioperative complication rate in patients with oral squamous cell carcinoma (OSCC). The medical records of 259 patients operated between 2014 and 2017 for OSCC were reviewed. Univariate and multivariate analyses were performed. Sixty of the 259 patients developed 87 complications. Low or high BMI was not associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade. Low BMI, American Society of Anesthesiologists score 2 and 3, a longer operating time, and increased blood loss were associated with a longer hospital stay. Low BMI was associated with a longer hospital stay. Neither low nor high BMI was associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade.
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Affiliation(s)
- W Do
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Elzerman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - E M Van Cann
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands.
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40
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Brorson F, Thorarinsson A, Kölby L, Elander A, Hansson E. Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients. Eur J Surg Oncol 2020; 46:2208-2217. [PMID: 32807615 DOI: 10.1016/j.ejso.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND There is little high-quality scientific evidence identifying the best and safest methods for delayed breast reconstruction, with most previous studies retrospective in nature. The primary aim was to compare early complication rates for two different breast-reconstructive methods in radiated and non-radiated patients, using a validated scale. The secondary aim was to identify predictors for complications. MATERIALS AND METHODS This study represents a clinical, randomized, prospective trial (ClinicalTrials.Gov identifier: NCT03963427), where the patients were divided into two study arms: non-radiated and radiated. In the non-radiated arm, patients were randomized to a one-stage lateral thoracodorsal flap with an implant or two-stage expander reconstruction. In the radiated arm, patients were randomized to a latissimus dorsi reconstruction combined with an implant or deep inferior epigastric artery perforator (DIEP) reconstruction. All adverse events were classified according to Clavien-Dindo and summarization of overall morbidity was performed by calculating the Comprehensive Complication Index score. The study was conducted from 2008 to 2020. RESULTS The complication frequencies were similar for the two surgical methods within each arm. In the non-radiated arm, risk factors for any complication were any comorbidities, and in the radiated arm, factors were a high body mass index and a contralateral operation. CONCLUSIONS The usage of the Clavien-Dindo scale in reconstructive surgery is feasible, but further validation is needed. In non-radiated patients, the frequencies of short-term complications were similar for lateral thoracodorsal flap and expander reconstruction, whereas in radiated patients, they were similar for DIEP and latissimus dorsi. The complication profile of the methods varied.
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Affiliation(s)
- Fredrik Brorson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Andri Thorarinsson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
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The prognostic implications of comorbidity and risk factors for (post)operative complications, days spent in the intensive care unit (ICU), and length of hospitalization in patients with oral squamous cell carcinoma: A prospective study. J Craniomaxillofac Surg 2020; 48:868-874. [PMID: 32753120 DOI: 10.1016/j.jcms.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study aimed to investigate the prognostic implications of comorbidity/risk factors in a cohort of patients with OSCC. METHODS The prospective study included patients with biopsy-proven primary OSCC. The impact of potential predictors on (post)operative complications, days spent in the ICU, and length of hospitalization was analyzed using both univariate and multivariate analysis. RESULTS Using a microvascular free flap (p = 0.009) and tobacco abuse (p = 0.005) had statistically significant impacts on postoperative complications in univariate, but not in multivariate, analysis. The duration of anesthesia (p < 0.001), type of neck dissection (p = 0.014), reconstruction type (p < 0.001), and red blood cell transfusion during operation (p = 0.007) had statistically significant impacts on spending ≥ 3 days in ICU in univariate analysis, with reconstruction type (p = 0.022) and red blood cell transfusion during operation (p = 0.034) having similar impacts in multivariate analysis. The duration of anesthesia (p < 0.001), pT (p = 0.009), type of neck dissection (p = 0.046), reconstruction type (p < 0.001), and microvascular free flap (p < 0.001) had a statistically significant impacts on length of hospitalization in univariate analysis, with reconstruction type (p < 0.001) also having a significant impact in multivariate analysis. CONCLUSION None of the investigated variables showed a significant effect on the prediction of (post)operative complications according to the Clavien-Dindo classification. The type of reconstruction proved to be a valid predictor for the time spent in ICU as well as for the overall length of hospitalization. Red blood cell transfusion during operation further predicted the time spent in ICU after operation. Both variables should be taken into account when performing a comprehensive planning of the patients' hospitalization.
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Brar S, Ofo E, Hyde N, Kim D, Odutoye T, Allin D, Rovira A. Outcomes of elective head and neck confirmed or suspected cancer surgery during the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2020; 278:1277-1282. [PMID: 32671539 PMCID: PMC7362766 DOI: 10.1007/s00405-020-06194-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/04/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To analyse the complication outcomes of COVID-19 negative patients undergoing elective head and neck surgery during the COVID-19 pandemic. METHODS This was a retrospective case review of all patients undergoing elective head and neck surgery for confirmed or suspected head and neck cancer. RESULTS There were no mortalities recorded in the cohort of patients analysed. At 30 days, pulmonary complications had occurred in 4 patients (9%). None of these were related to COVID infection. CONCLUSION With careful pre-operative screening of patients for COVID-19 and post-operative care in a COVID-19 clean ward, head and neck surgery can proceed safely during the epidemic. This data could help to minimise delay in treatment by allowing a greater number of elective head and neck cancer operations to proceed.
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Affiliation(s)
- Sabrina Brar
- ENT Department, St George's University Hospital, London, UK.
| | - Enyi Ofo
- ENT Department, St George's University Hospital, London, UK
| | - Nicholas Hyde
- Oral and Maxillofacial Surgery Department, St George's University Hospital, London, UK
| | - Dae Kim
- ENT Department, St George's University Hospital, London, UK
| | - Tunde Odutoye
- ENT Department, St George's University Hospital, London, UK
| | - David Allin
- ENT Department, St George's University Hospital, London, UK
| | - Aleix Rovira
- ENT Department, St George's University Hospital, London, UK
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Validation of the Adapted Clavien-Dindo in Trauma (ACDiT) Classifications in Medical and Surgical Management of Acute Diverticulitis. Ann Surg 2020; 275:e415-e419. [PMID: 32568744 DOI: 10.1097/sla.0000000000003888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To validate the adapted Clavien-Dindo in trauma (ACDiT) tool as a novel outcome measure for patients with acute diverticulitis managed both operatively and nonoperatively. BACKGROUND Complications following diverticulitis are difficult to classify because no traditional tools address patients managed both operatively and nonoperatively. The ACDiT grading system-graded from 0 to 5b-is applied in this manner but has not yet been validated for this patient group. METHODS We performed a 5-year observational study of patients with acute diverticulitis at a safety-net hospital. Baseline demographics and hospitalization data were collected. ACDiT scores were assigned, and validation was undertaken by comparing scores with hospital-free days, and verifying that higher scores were associated with known risk factors for poor outcomes. Inverse probability weighted propensity scores were assigned for surgical management, and inverse probability weighted regression analysis was used to determine factors associated with ACDiT ≥ grade 2. RESULTS Of 260 patients, 188 (72%) were managed nonoperatively. Eighty (31%) developed a complication; 73 (91%) were grades 1 to 3b. Higher grades correlated inversely with hospital-free days (rs = -0.67, P < 0.0001) for all patients and for nonoperative (rs = -0.63, P < 0.0001) and operative (rs = -0.62, P < 0.0001) patients. Hinchey 2 to 3 and initial operative management had higher odds of having a complication of ACDiT ≥ grade 2. CONCLUSION The ACDiT tool was successfully applied to acute diverticulitis patients managed operatively and nonoperatively, is associated with known risk factors for adverse outcomes. ACDiT may be considered a meaningful outcome measure for comparing strategies for acute diverticulitis.
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Bajwa MS, Carruthers S, Hanson R, Jackson R, Braithwaite C, Edwards M, Chauhan S, Smith CT, Shaw RJ, Schache AG. Determining the effectiveness of fibrin sealants in reducing complications in patients undergoing lateral neck dissection (DEFeND): study protocol for a randomised external pilot trial. Pilot Feasibility Stud 2020; 6:76. [PMID: 32509321 PMCID: PMC7251660 DOI: 10.1186/s40814-020-00618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Complications after major surgery are a significant cause of morbidity and mortality. Neck dissection is one of the most commonly performed major operations in Head and Neck Surgical Oncology. Significant surgical complications occur in approximately 10-20% of all patients, increasing to 40% in patients who have had previous treatment to the area or have multiple co-morbidities and/or polypharmacy.Current evidence suggests that fibrin sealants (FS) may have potential clinical advantages in Head and Neck Surgery through the reduction of complications, volume of wound drainage and retention time of the drains. However, a paucity of high-quality trial-based evidence means that a surgical trial to determine the effectiveness of FS in reducing the rate and severity of complications in patients undergoing lateral neck dissection is warranted. The DEFeND randomised external pilot trial will address critical questions on how well key components of the proposed study design work together as well as the feasibility of a future phase III trial. Methods The study design that is being piloted is that of a two-arm, parallel group, superiority trial with block randomisation in a 1:1 allocation ratio. The interventional arm will constitute the application of FS (Artiss, Baxter Healthcare Ltd.) to the surgical wound following completion of a neck dissection procedure, in addition to standard of care (SOC). The control arm will constitute SOC alone. Eligible patients will include patients who require a lateral neck dissection with a minimum of three cervical nodal levels. Patients who require bilateral neck procedures or undergoing immediate reconstruction with free or regional flaps will be excluded. The outcomes being assessed will be recruitment rate, screened to randomisation rate, fidelity of blinding process using blinding indices, number of missing or incomplete data entries, number of protocol deviations and number of losses to follow-up. Suitability of the outcome measures proposed for the future phase III trial will also be assessed. Discussion The anticipated challenges for this study will be recruitment, complexity of the intervention and adherence to the protocol. The outcomes will inform the design, feasibility and conduct of a future phase III surgical trial. Trial registration First participant randomised: November 06, 2018; UKCRN Portfolio ID: 37896; ISRCTN99181100.
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Affiliation(s)
- Mandeep S Bajwa
- Liverpool Head and Neck Centre, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Stacey Carruthers
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Rob Hanson
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Richard Jackson
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Chris Braithwaite
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Mike Edwards
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Seema Chauhan
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | | | - Richard J Shaw
- Liverpool Head and Neck Centre, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Andrew G Schache
- Liverpool Head and Neck Centre, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Henneman R, Berger DM, Karakullukcu MB, Smeele LE, Lohuis PF, Jóźwiak K, van der Hage JA, Balm AJ. Surgical site complications after parotid gland surgery for benign tumors in a centralized setting: A Clavien-Dindo class cohort analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:258-262. [DOI: 10.1016/j.ejso.2019.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
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Steinbichler TB, Golm L, Dejaco D, Riedl D, Kofler B, Url C, Wolfram D, Riechelmann H. Surgical rescue for persistent head and neck cancer after first-line treatment. Eur Arch Otorhinolaryngol 2020; 277:1437-1448. [PMID: 31982945 PMCID: PMC7160075 DOI: 10.1007/s00405-020-05807-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). METHODS Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND). RESULTS During the observation period, 35 patients received ND only and 17 primary site surgery ± ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery ± ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p = 0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5 ± 2; p = 0.07). CONCLUSION Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site ± ND should expect complications and permanent functional impairment.
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Affiliation(s)
- Teresa Bernadette Steinbichler
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - L Golm
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - D Dejaco
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - D Riedl
- Department of Medical Psychology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - B Kofler
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - C Url
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - D Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - H Riechelmann
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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Impact of nutritional status at the outset of assessment on postoperative complications in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:393-398. [PMID: 31870765 DOI: 10.1016/j.anorl.2019.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Half of the patients presenting with head and neck tumor are malnourished at the outset of treatment. Muscle mass loss (sarcopenia) seems to be critical. The aim of the present study was to assess the impact of nutritional status and sarcopenia on postoperative complications in head and neck cancer. MATERIALS AND METHODS A retrospective study for the period November 2014 to May 2016 included 92 patients operated on for head and neck squamous cell carcinoma. Complications at 30 days were graded on the 5-level Clavien-Dindo classification. Nutritional status was assessed anthropometrically (weight), biologically (albuminemia and Nutrition Risk Index (NRI)), on CT (muscle mass index at 3rd lumbar vertebra) and functionally (Short Physical Performance Battery). Assessment was made at the outset of management, and nutritional treatment was initiated as appropriate. Potential risk factors for postoperative complications were assessed: performance status, prior radiation therapy, smoking and alcohol abuse. RESULTS 54% of patients were malnourished on the NRI. 41% had grade≥2 complications. The most frequent complications were infection and healing disorder. The risk of complications was higher in case of malnutrition (62% vs. 17%; P<0.001) and sarcopenia (56% vs. 22%; P<0.01), with 50% longer hospital stay (P=0.04). CONCLUSION Malnutrition and sarcopenia are independent risk factors for postoperative complications.
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Guazzo E, Bowman J, Porceddu S, Webb L, Panizza B. Advanced adenoid cystic carcinoma of the skull base – The role of surgery. Oral Oncol 2019; 99:104466. [DOI: 10.1016/j.oraloncology.2019.104466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/03/2019] [Accepted: 10/22/2019] [Indexed: 01/30/2023]
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Zaroni FM, Cavalcante RC, João da Costa D, Kluppel LE, Scariot R, Rebellato NLB. Complications associated with orthognathic surgery: A retrospective study of 485 cases. J Craniomaxillofac Surg 2019; 47:1855-1860. [PMID: 31813754 DOI: 10.1016/j.jcms.2019.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To identify the most prevalent types of complications associated with orthognathic surgery and its possible risk factors. METHODS This study was a retrospective investigation of records of 485 patients who underwent orthognathic surgery between 2008 and 2014 at the Oral and Maxillofacial Surgery Service at the Federal University of Paraná, Curitiba, Brazil. Types of complications were recorded. Independent variables such as sex, age, duration of surgery and hospitalization, number of surgeries, surgical site, and types of osteotomy performed were evaluated. Complications were also evaluated based on the treatment according to the Clavien-Dindo Classification. Data were submitted to statistical analysis with a significance level of 0.05. RESULTS A total of 93 complications were reported (19.2%), including postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split, and infection. Complications were more common in men (p = 0.029). The number of complications was higher in surgeries that took more time to perform (p < 0.05) when the entire sample was taken into consideration. The prevalence of complications was related to a higher number of procedures per surgery (p = 0.019). Complications were more frequent in mandibular procedures (p = 0.010), particularly in bilateral sagittal split osteotomies (p < 0.001). Related to treatment, Clavien-Dindo grade I complications were the most frequent (72.04%). There was no association between sex, age, surgery duration, length of hospitalization, or surgical site with complication grades according to the Clavien-Dindo classification (p ≥ 0.05). CONCLUSION Postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split and infection are the most prevalent complication in orthognathic surgery. They seem to be related to sex, duration of surgery, number of surgeries, surgical site, and the type of osteotomy performed. With these in mind, it is possible to explain to the patient the different levels of severity of complications related to the surgery.
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Affiliation(s)
- Fabio Marzullo Zaroni
- Department of Stomatology, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400, Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Rafael Correia Cavalcante
- Department of Stomatology, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400, Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Delson João da Costa
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Leandro Eduardo Kluppel
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil.
| | - Rafaela Scariot
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil; School of Health Science, Oral and Maxillofacial Surgery Department, Positivo University, 5300 Professor Pedro Viriato Parigot de Souza Street, Campo Comprido, 81280-330, Curitiba, Paraná, Brazil.
| | - Nelson Luis Barbosa Rebellato
- School of Health Science, Oral and Maxillofacial Surgery Department, Federal University of Paraná, Av. Pref. Lothário Meissner, 3400 - Jardim Botânico, Curitiba, Paraná, Brazil.
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50
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Jain PV, Bang B, Manikantan K, Sinha T, Biswas G, Arun P. Factors Affecting Postoperative Complications After Reconstructive Surgery in Oral Carcinoma Patients: A Prospective Study of 100 Patients. Indian J Otolaryngol Head Neck Surg 2019; 71:341-347. [PMID: 31741983 DOI: 10.1007/s12070-018-1304-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022] Open
Abstract
Postoperative complications may result in significant functional morbidity, poor cosmetic results, prolonged hospitalization, preclusion of optimal treatment for the cancer, or even be pose threat to life. We prospectively assessed postoperative complications in 100 patients who underwent surgical resection with free or pedicled flap reconstruction as a primary modality of treatment in patients with carcinoma of the oral cavity. One hundred consecutive patients who underwent reconstructive surgery for oral cancer were prospectively analyzed for age, gender, comorbidities, tumor stage, nodal stage, primary sub-site of tumour, reconstructive procedure (free or pedicled), duration of surgery, blood transfusions during surgery, preoperative weight and body mass index, patient generated subjective global assessment status and tracheostomy to determine their effect on postoperative complications as determined on the CD scale. The sample comprised 100 patients with a mean age of 52.12 years (range 24-80 years) and 74% men (M:F ratio 3:1). A total of 40 patients developed surgical complications (including two deaths) while medical complications were seen in 10 patients (including one death). Tracheostomy (52 vs. 7%, p = 0.002) and age (54 vs. 49 years, p = 0.031) were associated with higher complication rate. Higher age and tracheostomy is associated with higher complications in postoperative period.
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Affiliation(s)
- Prateek Vijay Jain
- 1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700156 India
| | - Bhavesh Bang
- 1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700156 India
| | - Kapila Manikantan
- 1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700156 India
| | - Tiash Sinha
- 2Department of Clinical Nutrition, Tata Medical Center, Kolkata, West Bengal India
| | - Gautam Biswas
- 3Department of Plastic and Reconstructive Surgery, Tata Medical Center, Kolkata, West Bengal India
| | - Pattatheyil Arun
- 1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700156 India
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