Optimising Microsurgical Reconstruction After Advanced Head and Neck Cancers
关键词
抽象
描述
Advanced stage head and neck cancers have a poor prognosis and a 5-year survival rate of as low as 35-37%. The treatment is complex and often requires a multidisciplinary approach including surgery. The goal besides removal of the cancer is to restore function and appearance. If possible, both resection as well as immediate reconstruction will be performed during the same surgical procedure. Due to the large bone- and soft tissue loss following the ablative procedure, local solutions are often inadequate for reconstruction. In addition, many patients require post-operative radiotherapy, which may result in tightness of scar tissue and impaired function. In these cases it is necessary to perform the reconstruction using a free flap.
Free flap reconstruction involves tissue taken from other parts of the body, that is transplanted along with the associated blood vessels to the reconstruction site. The vessels of the flap are usually anastomosed to the vessels of the neck (microvascular reconstruction) and the transplanted tissue thereby obtains a blood supply at its new location. Head and neck cancer patients are usually reconstructed using the free fibular flap, the latissimus dorsi flap, the radial forearm flap or the anterolateral thigh flap.
The combination of complicated surgery and often malnourished patients with a low body mass index (BMI), that typically suffer from tobacco and alcohol abuse, commonly lead to postoperative ICU treatment and complications. The most common are infections, re-operations, delayed wound healing and refeeding syndrome, which is reported in up to 35% of patients undergoing major surgery for head and neck cancer.
Even with successful reconstruction, many patients suffer from drooling, lack of adequate clenching, permanent gastric tube feeding, insufficient wound healing and a high recurrence rate. Enhanced recovery after surgery (ERAS) is a peri- and postoperative care concept designed to accelerate recovery and improve convalescence. It has previously been established as superior to conventional care for a wide variety of procedures. As one of the first departments in the world our department has successfully implemented an ERAS program for microsurgical patients that undergo breast reconstruction using autologous tissue. By utilizing our experience with ERAS and combining it with a review of our own patient data we have developed an ERAS protocol for microvascular reconstruction after ablative surgery for head and neck cancer.
日期
最后验证: | 02/29/2020 |
首次提交: | 03/10/2020 |
提交的预估入学人数: | 03/10/2020 |
首次发布: | 03/15/2020 |
上次提交的更新: | 03/20/2020 |
最近更新发布: | 03/23/2020 |
实际学习开始日期: | 05/31/2019 |
预计主要完成日期: | 01/30/2021 |
预计完成日期: | 03/30/2021 |
状况或疾病
干预/治疗
Behavioral: ERAS Group
Behavioral: ERAS Group
Other: ERAS Group
Procedure: ERAS Group
Procedure: ERAS Group
Other: ERAS Group
Other: Control group
相
手臂组
臂 | 干预/治疗 |
---|---|
ERAS Group Prospectively included patients after introduction of an ERAS programme | Behavioral: ERAS Group Early ambulation will help prevent postoperative infections, especially pneumonia and urinary tract infections. Additionally it will prevent constipation by promotion of bowel-movement and function and prevent thromboembolic complications. Patients undergoing surgery with a free fibula flap are currently unable to ambulate for 6 to 7 days while a split-thickness skin-graft is healing. We will apply a pressure dressing to the wound which makes ambulation possible immediately after surgery (or after return from the ICU). Likewise, all other patient groups will be encouraged to fully ambulate on POD (post-operative day) 1 or POD 2. |
Control group We retrospectively evaluated our procedures for the period 2014-2016 | Other: Control group Non-formalised historical peri- and postoperative regimen. |
资格标准
有资格学习的年龄 | 18 Years 至 18 Years |
有资格学习的性别 | All |
取样方式 | Non-Probability Sample |
接受健康志愿者 | 没有 |
标准 | Inclusion Criteria: - Patients eligible for ablative surgery for head and neck cancer with primary microvascular reconstruction. Exclusion Criteria: - Patients with conditions leading to increased risk of thromboembolic events - Patients pre-operatively admitted to the ICU |
结果
主要结果指标
1. Length of stay (LOS) [1 to 4 weeks]
次要成果指标
1. ICU LOS [1-2 days]
2. Time to ambulation [1-7 days]
3. Incidence of infections [30 days]
4. Incidence of re-operations [30 days]
5. Complication-rate [30 days]