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Telischi J, Nisenbaum E, Nicolli E. Carotid endarterectomy for the management of carotid stenosis occurring concurrently with head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2023; 31:452-456. [PMID: 37916904 DOI: 10.1097/moo.0000000000000928] [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: 11/03/2023]
Abstract
PURPOSE OF REVIEW Currently, most patients with concurrent head and neck cancer (HNC) and carotid stenosis (CS) are treated disjointedly for their oncologic and vascular lesions. The purpose of this review is to evaluate literature exploring a novel approach to these cases that poses several advantages, in which carotid endarterectomy (CEA) is performed simultaneously with surgical resection of HNC. RECENT FINDINGS Carotid stenosis is a common comorbidity of patients presenting with head and neck cancer as these pathologies have overlapping risk factors. Adjuvant oncologic therapy such as radiation therapy to the site of the lesion is known to increase development or progression of carotid stenosis. Performing simultaneous surgical management of CS and HNC decreases total procedures for the patient, provides a less challenging surgical field, and eliminates prioritization of treatment initiation for one pathology over the other. There has been limited reporting of simultaneous CEA with oncologic resection of HNC in the literature. However, of the 21 cases reviewed here, no perioperative strokes were reported with only one perioperative death from myocardial infarction. SUMMARY Available literature supports that simultaneous CEA with oncologic resection of HNC is safe and may offer several advantages, although larger studies are required.
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Affiliation(s)
- Julia Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine
| | - Eric Nisenbaum
- Department of Otolaryngology, University of Miami Miller School of Medicine
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Elizabeth Nicolli
- Department of Otolaryngology, University of Miami Miller School of Medicine
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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Sanjuan-Sanjuan A, Ogledzki MJ, Haouilou JC, Ramirez CA. Neck dissection for head and neck malignancies with concurrent carotid endarterectomy. Int J Oral Maxillofac Surg 2023; 52:1120-1126. [PMID: 37062645 DOI: 10.1016/j.ijom.2023.03.010] [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: 11/18/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023]
Abstract
Head and neck malignancies share similar risk factors as carotid artery stenosis and these can often present together. Patients who require external beam radiotherapy are at a higher risk of developing significant worsening stenosis. The workup of the oncologic patient often includes computed tomography, which can reveal underlying carotid artery stenosis, offering an opportunity to address both conditions in one operation and prevent the need for a complicated carotid endarterectomy (CEA) in irradiated and previously operated tissue. It was postulated that these two operations can be combined safely. The surgical protocol, surgical technique, and outcomes of a case series of four patients with head and neck cancer who underwent neck dissection and CEA for carotid artery stenosis during the same operation is presented. CEA was performed safely, simultaneously with neck dissection. CEA did not affect the surgical outcomes or postoperative course of the patients, and no minor or major complications were observed related to this procedure. Carotid endarterectomy performed by a vascular surgeon can be safely combined with oncologic neck dissection in the same procedure to avoid future complications in head and neck cancer patients.
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Affiliation(s)
- A Sanjuan-Sanjuan
- Oral and Maxillofacial Surgery Department, Ascension-St. John Hospital, Detroit, Michigan, USA
| | - M J Ogledzki
- Oral and Maxillofacial Surgery Department, Ascension-St. John Hospital, Detroit, Michigan, USA
| | - J C Haouilou
- Vascular Surgery, Department of Surgery, Ascension-St. John Hospital, Detroit, Michigan, USA
| | - C A Ramirez
- Oral and Maxillofacial Surgery Department, Ascension-St. John Hospital, Detroit, Michigan, USA.
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Incidence of Internal Carotid Artery Stenosis in Oral Squamous Cell Carcinoma Patients After Neck Dissection. J Craniofac Surg 2023; 34:e199-e202. [PMID: 36138543 DOI: 10.1097/scs.0000000000009042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To determine the incidence of progressive internal carotid artery stenosis (ICAS) by head and neck contrast-enhanced computed tomography (CT) in 45 patients who underwent neck dissection for oral squamous cell carcinoma (OSCC). PATIENTS AND METHODS The study included 45 patients who underwent head and neck contrast-enhanced CT before and after surgery for OSCC by the Hu Yongjie team at the Department of Oral and Maxillofacial-Head & Neck Oncology of Shanghai Ninth People's Hospital in 2016 and were followed up for 5 years. RESULTS Comparison of the current CT with previously obtained head and neck contrast-enhanced CT images revealed progressive ICAS in 3 patients with a mean age of 50.0 years. All 3 patients were male, and their OSCC sites were the tongue in 2 patients and the buccal in 1 patient. Tumor resection and neck dissection were performed for all 3 patients. Two patients underwent radiotherapy. In all 3 patients, the ICAS had occurred on the same side as the tumors. CONCLUSIONS The results of this study suggest that neck dissection with cervical sheath removal might increase the incidence of ICAS, but this result may need the support of a larger sample size study.
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Melachuri S, Melachuri M, Vallapil B, Kim S, Snyderman C. The incidence of stroke post neck dissection surgery and perioperative management. Am J Otolaryngol 2022; 43:103360. [PMID: 34972004 DOI: 10.1016/j.amjoto.2021.103360] [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: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Head and neck surgery encompasses major vessels, raising the concern of life-threatening complications such as stroke. METHODS Databases at UPMC were queried to identify patients with both neck dissections and stroke from January 1st, 2004, to October 1st, 2020. A retrospective chart review was performed to identify patients who experienced a stroke within 30 days of a neck dissection. RESULTS Search of a UPMC database for carotid artery stenosis (CAS), transient ischemic attack (TIA), and stroke identified 20,527 patients. After matching with the Head and Neck Tumor Registry patients, 41 of 4230 patients with a neck dissection also had a stroke, TIA, or CAS in their lifetime. One patient, with multiple risk factors, despite pre-operative precautions, had a stroke 2 days post neck dissection in the setting of carotid occlusion from hypercoagulability of malignancy and intraoperative vessel injury. The patient subsequently underwent a carotid thrombectomy and vein patch repair and has had no additional cerebrovascular accidents. CONCLUSION Although the incidence of stroke post neck dissection is minimal, patients with multiple risk factors for stroke should be managed carefully to prevent deleterious outcomes.
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Jung S, Na S, Kim HB, Joo HJ, Kim J. Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation. Acute Crit Care 2020; 35:197-204. [PMID: 32772035 PMCID: PMC7483012 DOI: 10.4266/acc.2020.00213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Although the use of volatile sedatives in the intensive care unit (ICU) is increasing in Europe, it remains infrequent in Asia. Therefore, there are no clinical guidelines available. This study investigates the proper initial concentration of sevoflurane, a volatile sedative that induces a Richmond agitation-sedation scale (RASS) score of –2 to –3, in patients who underwent head and neck surgery with tracheostomy. We also compared the amount of postoperative opioid consumption between volatile and intravenous (IV) sedation. Methods We planned a prospective study to determine the proper initial sevoflurane concentration and a retrospective analysis to compare postoperative opioid consumption between volatile sedation and propofol sedation. Patients scheduled for head and neck surgery with tracheostomy and subsequent postoperative sedation in the ICU were enrolled. Results In this prospective study, the effective dose 50 (ED50) of initial end-tidal sevoflurane concentration was 0.36% (95% confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI, 0.60 to 0.75%) based on isotonic regression methods. In this retrospective study, remifentanil consumption during postoperative sedation was significantly lower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in the IV propofol group (3.66±1.30 µg/kg/hr). Conclusions We determined the proper initial end-tidal concentration setting of sevoflurane for patients with tracheostomy who underwent head and neck surgery. Postoperative sedation with sevoflurane appears to be a valid and safe alternative to IV sedation with propofol.
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Affiliation(s)
- Seungho Jung
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Bin Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ji Joo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Park B, Min C, Choi HG. Neck dissection does not increases the risk of stroke in thyroid cancer: A national cohort study. PLoS One 2018; 13:e0195074. [PMID: 29596481 PMCID: PMC5875838 DOI: 10.1371/journal.pone.0195074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 03/16/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The purpose of this study is to evaluate the risk of stroke (hemorrhagic or ischemic) after neck dissection in thyroid cancer patients in Korea using national cohort data. Methods Using the national cohort study from the Korean Health Insurance Review and Assessment Service, patients with neck dissection for thyroid cancer (1,041) and control participants (4,164) were selected and matched 1:4 (age, gender, income, and region of residence). The Chi-square test, Fischer’s exact test, and the Cox-proportional hazard model were used. The Cox-proportional analysis used a crude model and an adjusted model for age, gender, income, region of residence, hypertension, diabetes, dyslipidemia. Results None of the participants had suffered hemorrhagic stroke in the neck dissection group, while 0.3% (13/4,164) of participants had suffered hemorrhagic stroke in the control group (P = 0.085). In total, 0.8% (8/1,041) of participants had suffered an ischemic stroke in the neck dissection group, and 0.7% (31/4,133) of participants had suffered an ischemic stroke in the control group (P = 0.936). The adjusted hazard ratio for ischemic stroke after neck dissection was 1.06 (95% confidence interval [CI] = 0.49–2.31, P = 0.884). Conclusion The risk of hemorrhagic or ischemic stroke was not higher in thyroid cancer patients who underwent neck dissection than that in the matched control group.
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Affiliation(s)
- Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
- * E-mail:
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Cramer JD, Patel UA, Maas MB, Samant S, Smith SS. Is Neck Dissection Associated with an Increased Risk of Postoperative Stroke? Otolaryngol Head Neck Surg 2017; 157:226-232. [PMID: 28417663 DOI: 10.1177/0194599817698414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Prior studies have reported widely disparate rates of postoperative stroke, with conflicting analyses of whether neck dissection is an independent risk factor. Study Design Cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013. Subjects and Methods We compared the 30-day rate of postoperative stroke between patients undergoing complete or modified radical neck dissection and a control cohort composed of those undergoing resections in the oral cavity, oropharynx, larynx, or hypopharynx without neck dissection. Propensity scores and paired statistics were used to compare the groups while adjusting for relevant covariates. Results We identified 9697 patients, including 5827 with neck dissection and 3870 without neck dissection. In the full cohort, the rate of postoperative stroke was greater with neck dissection than without it (0.31% vs 0.11%, P = .052), although the relationship was attenuated by propensity score matching to adjust for comorbidities (0.30% vs 0.13%, P = .18). Among patients with ≥2 risk factors for carotid artery stenosis, neck dissection was associated with an increased rate of postoperative stroke (2.68% with bilateral neck dissection, 0.41% with unilateral neck dissection, and 0.24% without neck dissection, P = .04). The incidence of stroke was strongly associated with 30-day mortality (7.4% vs 0.2%, P < .001). Conclusions Stroke is a rare but highly morbid complication after head and neck surgery. Compared with other head and neck surgery, neck dissection in patients at risk for carotid artery stenosis is associated with an increased risk of postoperative stroke.
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Affiliation(s)
- John D Cramer
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet A Patel
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,2 Division of Otolaryngology-Head and Neck Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Matthew B Maas
- 3 Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie Shintani Smith
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,4 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sukegawa S, Kanno T, Kanai K, Mandai T, Shibata A, Takahashi Y, Hirata Y, Furuki Y. Perioperative stroke in a patient undergoing surgery for oral cancer: A case report. Oncol Lett 2016; 12:2660-2663. [PMID: 27698839 DOI: 10.3892/ol.2016.5031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/19/2016] [Indexed: 11/05/2022] Open
Abstract
Carotid artery stenosis is a significant risk factor for stroke. In elderly patients with carotid atherosclerosis and stenosis, it is not unusual for oral, head and neck cancer surgery to be performed. The present study describes a case of stroke that occurred during a neck dissection for the treatment of cervical lymph node metastasis of a left maxillary gingival carcinoma. The patient was an 84-year-old female who was considered to be at high risk of a stroke based on pre-operative head and neck computed tomography scans, which detected severe carotid atherosclerosis and stenosis. There was no possible stroke prophylaxis available during the performance of the neck dissection in the present case. However, if patients are evaluated to be high-risk pre-operatively, statin agents should be administered, the surgery should be carefully performed, adequate sedation should be maintained post-operatively and the patient should be followed up, aiming to achieve the early detection of a possible stroke.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Kengo Kanai
- Department of Otorhinolaryngology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
| | - Toshiko Mandai
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Akane Shibata
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Yuka Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Yuji Hirata
- Department of Otorhinolaryngology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
| | - Yoshihiko Furuki
- Department of Otorhinolaryngology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
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Chang CF, Kuo YL, Pu C, Chou YJ. Neck dissection and stroke in patients with oral cavity cancer: A population-based cohort study. Head Neck 2016; 39:63-70. [DOI: 10.1002/hed.24535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chia-Fan Chang
- Department of Otolaryngology, Head and Neck Surgery; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Hospital and Health Care Management, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yen-Ling Kuo
- Department of Otolaryngology; National Yang-Ming University Hospital; Yilan County Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
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MacNeil SD, Liu K, Garg AX, Tam S, Palma D, Thind A, Winquist E, Yoo J, Nichols A, Fung K, Hall S, Shariff SZ. A Population-Based Study of 30-day Incidence of Ischemic Stroke Following Surgical Neck Dissection. Medicine (Baltimore) 2015; 94:e1106. [PMID: 26287406 PMCID: PMC4616442 DOI: 10.1097/md.0000000000001106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to determine the 30-day incidence of ischemic stroke following neck dissection compared to matched patients undergoing non-head and neck surgeries.A surgical dissection of the neck is a common procedure performed for many types of cancer. Whether such dissections increase the risk of ischemic stroke is uncertain.A retrospective cohort study using data from linked administrative and registry databases (1995-2012) in the province of Ontario, Canada was performed. Patients were matched 1-to-1 on age, sex, date of surgery, and comorbidities to patients undergoing non-head and neck surgeries. The primary outcome was ischemic stroke assessed in hospitalized patients using validated database codes.A total of 14,837 patients underwent surgical neck dissection. The 30-day incidence of ischemic stroke following the dissection was 0.7%. This incidence decreased in recent years (1.1% in 1995 to 2000; 0.8% in 2001 to 2006; 0.3% in 2007 to 2012; P for trend <0.0001). The 30-day incidence of ischemic stroke in patients undergoing neck dissection is similar to matched patients undergoing thoracic surgery (0.5%, P = 0.26) and colectomy (0.5%, P = 0.1). Factors independently associated with a higher risk of stroke in 30 days following neck dissection surgery were of age ≥75 years (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.53), and a history of diabetes (OR 1.60, 95% CI 1.02-2.49), hypertension (OR 2.64, 95% CI 1.64-4.25), or prior stroke (OR 4.06, 95% CI 2.29-7.18).Less than 1% of patients undergoing surgical neck dissection will experience an ischemic stroke in the following 30 days. This incidence of stroke is similar to thoracic surgery and colectomy.
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Affiliation(s)
- S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London (SDM, ST, JY, AN, KF); Institute for Clinical and Evaluative Sciences (SDM, KL, AXG, AT, SH, SZS); Department of Epidemiology and Biostatistics, Western University (AXG, AT); Department of Family Medicine, Western University (AT); Department of Oncology, Western University, London (SDM, DP, EW, JY, AN, KF); Department of Otolaryngology-Head and Neck Surgery, Cancer Care and Epidemiology, Queens University, Kingston (SH); Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada (AXG)
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Rozec B, Cinotti R, Le Teurnier Y, Marret E, Lejus C, Asehnoune K, Blanloeil Y. [Epidemiology of cerebral perioperative vascular accidents]. ACTA ACUST UNITED AC 2014; 33:677-89. [PMID: 25447778 DOI: 10.1016/j.annfar.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature. ARTICLE TYPE Systematic review. DATA SOURCES Firstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters. RESULTS In cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24-48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients. CONCLUSION Postoperative stroke is a quality marker of the surgical teams' skill and has specific onset time and induces an increase of postoperative mortality.
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Affiliation(s)
- B Rozec
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
| | - R Cinotti
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - Y Le Teurnier
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - E Marret
- Département d'anesthésie-réanimation, institut hospitalier franco-britannique, 4, rue Kléber, 92300 Levallois-Perret, France
| | - C Lejus
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - K Asehnoune
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - Y Blanloeil
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
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Shuman AG, Patel SG, Shah JP, Korc-Grodzicki B. Optimizing perioperative management of geriatric patients with head and neck cancer. Head Neck 2013; 36:743-9. [PMID: 23596001 DOI: 10.1002/hed.23347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/01/2013] [Accepted: 04/05/2013] [Indexed: 12/27/2022] Open
Abstract
Given emerging demographic trends, many more elderly patients are being diagnosed with head and neck cancers. The surgical care paradigm for this cohort of patients must take into account specific challenges inherent to geriatric perioperative management. This article attempts to summarize the existing body of literature relevant to the geriatric head and neck cancer population, and to extrapolate relevant data from geriatric perioperative medicine in order to better understand and guide management decisions. The involvement of geriatricians and of patients' primary care providers may be invaluable in assisting in complex perioperative decision-making and in participating in longitudinal management. Preoperative risk stratification and assessment of medical, social, and functional variables are critical for appropriate decision-making in this challenging patient population.
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Affiliation(s)
- Andrew G Shuman
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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13
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Ikawa H, Sato K, Tonogi M, Yamane GY, Kimura M, Tatsuno S, Aoyagi Y, Katakura A. Head and neck contrast-enhanced CT for identification of internal carotid artery stenosis progression on the affected side after treatment for oral squamous cell carcinoma. Oral Radiol 2013; 29:1-5. [PMID: 23293426 PMCID: PMC3532718 DOI: 10.1007/s11282-012-0099-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/28/2012] [Indexed: 12/03/2022]
Abstract
Objectives To determine the incidence of progressive internal carotid artery (ICA) stenosis by head and neck contrast-enhanced computed tomography (CT) in 82 patients who underwent surgery, chemotherapy, or combination therapy for oral squamous cell carcinoma (OSCC). Methods The study included 82 patients who underwent head and neck contrast-enhanced CT after surgery alone or combined surgery and chemotherapy for OSCC at the Department of Oral and Maxillofacial Surgery of Ichikawa General Hospital, Tokyo Dental College, or Tokyo Dental College Oral Cancer Center between December 2002 and March 2010. Results Comparison with previously obtained head and neck contrast-enhanced CT images revealed progressive arterial stenosis of the ICA in five patients with a mean age of 62.0 years. All five patients were male, and their OSCC sites were the tongue in two, the floor of the mouth in two, and the mandibular gingiva in one. Tumor resection and neck dissection were performed for four patients and tumor resection alone for one patient. Four patients underwent chemotherapy. ICA stenosis occurred on the same side as the tumor in all five patients. Conclusions The results of this study suggest that, given the possibility of post-treatment vascular events, attention must be paid to subsequent changes in the ICA over time. The results also indicate the usefulness of head and neck contrast-enhanced CT in identifying such problems.
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Affiliation(s)
- Hiroaki Ikawa
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Kazumichi Sato
- Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310 Japan
| | - Gen-yuki Yamane
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Masako Kimura
- Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Satoshi Tatsuno
- Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Yutaka Aoyagi
- Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Akira Katakura
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
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Kroeker TR, O'Brien JC. Outcomes of combined oncologic resection and carotid endarterectomy in patients with head and neck cancer. Head Neck 2012; 35:E167-70. [DOI: 10.1002/hed.22919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2011] [Indexed: 11/10/2022] Open
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15
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Macellari F, Paciaroni M, Agnelli G, Caso V. Perioperative Stroke Risk in Nonvascular Surgery. Cerebrovasc Dis 2012; 34:175-81. [DOI: 10.1159/000339982] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/04/2012] [Indexed: 02/02/2023] Open
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16
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Postoperative neurocognitive function and microembolus detection in patients undergoing neck dissection: a pilot study. Eur J Anaesthesiol 2010; 27:417-24. [PMID: 20394111 DOI: 10.1097/eja.0b013e328336c633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients undergoing oncologic neck dissection may have many of the risk factors for carotid artery stenosis, thus predisposing them to perioperative cerebral ischaemic events. The present study was designed to investigate development of postoperative neurocognitive dysfunction in these patients. METHODS Twenty-six patients were assessed the day before surgery and 48 h and 12 months after surgery using a comprehensive neuropsychological test battery. Cognitive performance was compared with a matched control group to account for the practise effect associated with repeated testing. Doppler ultrasonography was used to detect intraoperative cerebral microembolism. S100beta protein values were evaluated before and immediately after anaesthesia. RESULTS On the second postoperative day, 26.9% of patients undergoing neck dissection had postoperative neurocognitive deficit (POCD), defined as a total deficit score of 2SD worse than the mean performance in the control group. Microemboli were found only in the neck dissection group. S100beta levels were significantly higher after neck dissection (Wilcoxon signed ranked test: P<0.001). After 12 months, the incidence of POCD was similar in both groups. CONCLUSION POCD was detectable only after neck dissection in the early postoperative period accompanied by increased incidence of microembolism and protein S100beta levels, but not 12 months after surgery.
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17
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Brennan PA, Oeppen RS, Bater MC, Khosla N, Davies B, Puxeddu R, Atchley J. CT and duplex scanning: A comparison of imaging techniques for evaluation of the carotid tree in head and neck cancer patients. Oral Oncol 2008; 44:1009-13. [DOI: 10.1016/j.oraloncology.2008.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/13/2008] [Accepted: 02/13/2008] [Indexed: 11/26/2022]
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18
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Brennan PA. External carotid artery stenosis in patients with head and neck squamous cell carcinoma – A prospective study. Oral Oncol 2008; 44:301-4. [PMID: 17596998 DOI: 10.1016/j.oraloncology.2007.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 03/30/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
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19
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Thompson SK, Southern DA, McKinnon JG, Dort JC, Ghali WA. Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis. Ann Surg 2004; 239:428-31. [PMID: 15075662 PMCID: PMC1356243 DOI: 10.1097/01.sla.0000114130.01282.26] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the incidence of perioperative stroke in patients undergoing a neck dissection. SUMMARY BACKGROUND DATA The incidence of perioperative stroke in non-head and neck surgery is between 0.08 and 0.2%. In contrast, a critical review of the literature identified 2 studies stating the incidence of perioperative stroke in head and neck surgery to be 3.2% and 4.8%. The implications of these results are significant because they suggest a potential need for preoperative screening and/or intervention for carotid artery pathology. METHODS This historical cohort study was conducted using discharge data for all neck dissections performed in a geographically-defined health region in Alberta, Canada, from 1994 to 2002. Subjects were selected for study if they had an assigned ICD-9CM procedure code for a neck dissection at one of the region's 3 adult-care hospitals. Our main outcome measure was perioperative stroke. RESULTS Patients (n = 499) were identified as having had a neck dissection (mean age 56.5 +/- 15.3 SD, 65.3% male). Seven patients had ICD-9CM codes for postoperative central nervous system complications (incidence of 1.4%). However, on chart review, only one had had a true perioperative stroke corresponding to an incidence of 0.2% (95% confidence interval 0.01, 1.12). No missed strokes were found in a confirmatory random review of 10% of charts. CONCLUSIONS The incidence of perioperative stroke in this study is significantly lower than that previously stated in the literature. This suggests that preoperative screening and/or intervention for carotid artery disease may not be necessary in this patient population.
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Affiliation(s)
- Sarah K Thompson
- Department of Surgery, the Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada
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20
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Kokemueller H, Brachvogel P, Eckardt A, Hausamen JE. Neck dissection in oral cancer--clinical review and analysis of prognostic factors. Int J Oral Maxillofac Surg 2002; 31:608-14. [PMID: 12521316 DOI: 10.1054/ijom.2002.0265] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate the oncologic effectiveness of radical and different types of modified neck dissections with preservation of the spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle and to identify prognostic factors for regional control and survival in univariate and multivariate analysis. This retrospective study included 373 patients with squamous cell carcinoma of the oral cavity who underwent 401 neck dissections between January 1986 and December 1997 at the Department for Oral and Maxillofacial Surgery, Hanover Medical School. The actuarial neck control rate after 5 years was estimated with 87%. Neck failure occured only within the first 2 years after neck dissection. The number of positive nodes, macroscopic extracapsular spread, peeling off metastases from carotid artery and cranial base and preoperative radiochemotherapy were significant prognostic factors. Grade of metastases, microscopic extracapsular spread, lymphangiosis carcinomatosa and postoperative radiation showed no prognostic significance. The comparison of neck failures after radical and modified neck dissection demonstrated a tendency to improved regional control after radical neck dissection with increasing extent of neck disease.
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Affiliation(s)
- H Kokemueller
- Department of Oral and Maxillofacial Surgery, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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21
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Cote CR, Goff J, Barry P, Casler J. The prevalence of occult carotid artery stenosis in patients with head and neck squamous cell carcinoma. Laryngoscope 2001; 111:2214-7. [PMID: 11802028 DOI: 10.1097/00005537-200112000-00027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Risk factors for atherosclerotic carotid artery disease (ASCAD) and squamous cell carcinoma of the head and neck region (HNSCCA) are similar. This study was conducted to determine whether patients with HNSCCA have an increased rate of occult ASCAD compared with the general population. STUDY DESIGN A cross-sectional study was performed to identify the prevalence of clinically significant ASCAD in the specific population of patients with a diagnosis of HNSCCA using noninvasive color flow duplex imaging. In addition, the demographic variables and risk factors for head and neck cancer and for carotid disease, as identified in the literature, were recorded with the use of a questionnaire. METHODS Forty-nine patients with a diagnosis of HNSCCA completed the questionnaire and then had a duplex screening examination. RESULTS The most common risk factor identified was tobacco smoking in 41 of 49 patients (84%). ASCAD was identified in one patient (2%). The stenosis in that patient was less than 60%. CONCLUSIONS We conclude from this study that even though patients with HNSCCA usually have risk factor(s) associated with ASCAD, the rate of occult ASCAD was not different from that found in the general population. Thus, routine screening of patients with HNSCCA with color flow duplex imaging to detect occult ASCAD is not warranted.
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Affiliation(s)
- C R Cote
- Otolaryngology--Head and Neck Surgery Service, Walter Reed Army Medical Center, Washington, DC, USA
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