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Li Y, Li Z, Lv Q, Gu Y, Qi Y, Li J, Liu Y, Ma G. Prevalence and risk factors of postoperative delirium in tumor patients after free flap reconstruction: A systematic review and meta-analysis of case-control studies. Surgery 2024; 176:906-917. [PMID: 38910046 DOI: 10.1016/j.surg.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Postoperative delirium is a severe complication of flap transplantation surgery, adversely affecting surgical prognoses. The intricate pathophysiology of postoperative delirium renders the elucidation of its risk factors challenging. This research aims to delineate the prevalence and the specific risk factors of postoperative delirium in patients with cancer undergoing free flap reconstruction through a systematic review and meta-analysis to enlighten proactive prevention measures. METHODS The researchers systematically queried both the international and Chinese databases. Searches were performed for publications from inception until September 14, 2023, using the terms "free tissue flaps," "delirium," "neoplasms," and "risk factors." Data synthesis and statistical analysis were conducted using Stata SE (version 15.0) to calculate the combined effect size for identified risk factors. Reported outcomes included weighted mean differences or odds ratios with their respective 95% confidence intervals. RESULTS Twelve case-control studies were included (ntotal = 3,256). Among them, 515 patients developed postoperative delirium after free flap surgery, compared with 2,741 patients who did not. The outcomes suggest that the risk factors include but are not limited to age, male, late neoplasm staging, use of hypnotic or antipsychotic, history of background diseases, psychiatric review, tracheotomy, and impaired wound healing. In contrast, early neoplasm staging and others are the protective factors with statistical significance. Multivariate analysis further identified significant correlations between preoperative albumin, perioperative blood transfusion, sleep disturbance, postoperative visual analog scale, postoperative albumin, smoking, and the appearance of postoperative delirium. CONCLUSION The determined risk factors were grouped into preoperative, intraoperative, and postoperative categories substantiated by current data to present instructions for postoperative delirium prevention.
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Affiliation(s)
- Yifei Li
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Zhifeng Li
- First Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Peoples Republic of China
| | - Qianwen Lv
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Yunpeng Gu
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Yue Qi
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Jiyang Li
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Yicheng Liu
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Guie Ma
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China.
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Yamamoto T, Shinozaki T, Nishiya Y, Okano W, Tomioka T, Matsuura K, Furuse K, Oshima A, Higashino T, Hayashi R. Early enteral nutrition and mobilization following head and neck surgery with free flap reconstruction. Jpn J Clin Oncol 2024; 54:770-777. [PMID: 38555498 DOI: 10.1093/jjco/hyae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Perioperative management methods that reduce surgery-associated invasiveness and improve the quality of postoperative recovery are being promoted as enhanced recovery after surgery programs in various areas. Early enteral nutrition and mobilization are essential elements for enhanced recovery after surgery; however, their safety and feasibility are unclear in head and neck surgery with free tissue transfer reconstruction. This study aimed to clarify these uncertainties. METHODS This is a retrospective before-after study. From 2018 to 2022, 187 and 173 patients received conventional management on or before April 2020 and early management on or after May 2020, respectively. The conventional management and early management groups received enteral nutrition and mobilization on postoperative days 2 and 1, respectively. The primary outcome for safety assessment was the incidence of complications. The secondary outcome was the compliance rate of conventional management or early management for feasibility assessment and the length of hospital stay. RESULTS The clinical tumour-node-metastasis stage and American Society of Anesthesiologists physical status showed significant differences between the groups. In multivariable analysis, the early management group demonstrated a significantly lower incidence of treatment-required complication classified Clavien-Dindo Grade 2 and above (odds ratio = 0.57; 95% confidence interval = 0.31-0.92) and lower wound infection (odds ratio = 0.53; 95% confidence interval = 0.31-0.92). The early management group had lower compliance rate than the conventional management group; however, no statistically significant difference was observed (79.8% vs. 85.0%, P = 0.21). CONCLUSION Early management is safe and feasible following head and neck surgery with free tissue transfer reconstruction. It could reduce the complication rate and is considered a useful postoperative management method.
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Affiliation(s)
- Takuya Yamamoto
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukio Nishiya
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Wataru Okano
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kiichi Furuse
- Department of Plastic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Azusa Oshima
- Department of Plastic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuya Higashino
- Department of Plastic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Imai T, Asada Y, Matsuura K. Enhanced recovery pathways for head and neck surgery with free tissue transfer reconstruction. Auris Nasus Larynx 2024; 51:38-50. [PMID: 37558602 DOI: 10.1016/j.anl.2023.08.001] [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: 05/30/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The enhanced recovery after surgery (ERAS) pathway is designed to facilitate recovery after surgery by packaging evidence-based protocols specific to each aspect of the perioperative period, including the preoperative, intraoperative, postoperative, and post-discharge periods. The ERAS pathway, which was originally developed for use with colonic resection, is now being expanded to include a variety of surgical procedures, and the ERAS Society has published a consensus review of the ERAS pathway for head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). The ERAS pathway for HNS-FTTR consists of various important protocols, including early postoperative mobilization, early postoperative enteral nutrition, abolition of preoperative fasting, preoperative enteral fluid loading, multimodal pain management, and prevention of postoperative nausea and vomiting. In recent years, meta-analyses investigating the utility of the ERAS pathway in head and neck cancer surgery have also been presented, and all reports showed that the length of the postoperative hospital stay was reduced by the implementation of the ERAS pathway. The ERAS pathway is now gaining traction in the field of head and neck surgery; however, the details of its efficacy remain uncertain. We believe the future direction will require research focused on improving the quality of postoperative patient recovery and patient satisfaction. It will be important to use patient-reported outcomes to determine whether the ERAS pathway is actually beneficial.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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4
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Imai T, Takasago T, Momma Y, Chiba T, Nakanome A, Morita S, Hasegawa K, Ito K, Goto T, Asada Y. Efficacy of an enhanced recovery after surgery pathway to manage pain, nausea and vomiting after head and neck surgeries with free tissue transfer reconstruction. Jpn J Clin Oncol 2023; 53:1038-1044. [PMID: 37534546 DOI: 10.1093/jjco/hyad094] [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: 05/12/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Pain and post-operative nausea and vomiting are the main factors that impair the quality of recovery after surgery. Very few reports have analyzed patient-reported outcomes to investigate the efficacy of an enhanced recovery after surgery protocol to alleviate these symptoms after head and neck surgeries with free tissue transfer reconstruction. METHODS We investigated post-operative pain and post-operative nausea and vomiting in 47 patients who underwent head and neck surgeries with free tissue transfer reconstruction with enhanced recovery after surgery support between February 2021 and August 2022. Patient-reported outcomes were assessed using the visual analog scale and Japanese version of the Quality of Recovery-40. RESULTS Significant increases in the mean visual analog scale scores for pain and post-operative nausea and vomiting were observed only on post-operative Day 1 compared with preoperative values (pain: 3.19 ± 2.78 vs. 1.96 ± 2.42, P = 0.0408; post-operative nausea and vomiting: 1.52 ± 2.09 vs. 0.54 ± 1.37, P = 0.0194). From post-operative Day 2, there were no significant differences between the pre- and post-operative visual analog scale scores, and no significant increases in the incidences of moderate or severe pain and post-operative nausea and vomiting compared with preoperatively. The Japanese version of the Quality of Recovery-40 score for post-operative pain showed no significant deterioration compared with preoperatively, while the Japanese version of the Quality of Recovery-40 score for post-operative nausea and vomiting showed significant deterioration compared with the preoperative value on post-operative Days 2, 4 and 7. CONCLUSIONS The visual analog scale and Japanese version of the Quality of Recovery-40 scores for post-operative pain and visual analog scale score for post-operative nausea and vomiting suggested that the enhanced recovery after surgery strategy favorably controlled pain and post-operative nausea and vomiting after head and neck surgeries with free tissue transfer reconstruction. However, as the post-operative Japanese version of the Quality of Recovery-40 score for post-operative nausea and vomiting was lower than the preoperative value, there is still a need for further improvement of the enhanced recovery after surgery pathway.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Teiko Takasago
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yumiko Momma
- Department of Nursing, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Tomoyo Chiba
- Department of Nursing, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Ayako Nakanome
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Sinkichi Morita
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kohsei Hasegawa
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kazue Ito
- Department of Head and Neck Medical Oncology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
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Shinozaki T, Imai T, Kobayashi K, Yoshimoto S, Zenda S, Yamaguchi T, Eguchi K, Okano T, Mashiko T, Kurosaki M, Miyaji T, Matsuura K. Preoperative steroid for enhancing patients' recovery after head and neck cancer surgery with free tissue transfer reconstruction: protocol for a phase III, placebo-controlled, randomised, double-blind study (J-SUPPORT 2022, PreSte-HN Study). BMJ Open 2023; 13:e069303. [PMID: 37258074 DOI: 10.1136/bmjopen-2022-069303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION There is no established methodology for the perioperative management of head and neck cancer surgery and free tissue transfer reconstruction (HNS-FTR). A single dose of corticosteroid administered immediately before surgery has been shown to reduce postoperative pain and nausea/vomiting after some types of surgery. However, the efficacy of this strategy has not been demonstrated in HNS-FTR, and the increased risk of infectious complications associated with its use cannot be ruled out. This phase III, placebo-controlled, randomised, double-blind, comparative, multicentre study seeks to determine if preoperative administration of corticosteroid hormone has an adjunctive effect in terms of reducing pain and nausea/vomiting after surgery and improving the quality of postoperative recovery. METHODS AND ANALYSIS Using the minimisation method, patients undergoing HNS-FTR are currently being recruited and randomly assigned to a study arm at a 1:1 allocation rate. The study treatment arm consists of 8.0 mg of dexamethasone phosphate dissolved in 100 mL of saline administered as a single dose by intravenous infusion. These treatments will be administered in a double-blind fashion. All patients will receive perioperative care according to the common multicentre enhanced recovery after surgery programme. The primary endpoint is the quality of postoperative recovery, as determined by the area under the curve (AUC) for total score on the Japanese version of the Quality of Recovery Score (QOR-40J) on postoperative days 2 and 4. The point estimate and CI for the difference in the AUC between the groups on postoperative days 2 and 4 will be calculated. ETHICS AND DISSEMINATION The study will be performed in accordance with the Declaration of Helsinki and Japan's Clinical Trials Act. The study protocol was approved by the Certified Review Board of National Cancer Center Hospital East (Reference K2021004). TRIAL REGISTRATION NUMBER The study was registered in the Japan Registry of Clinical Trials (jRCTs031210593; V.3.0, November 2021, available at https://jrct.niph.go.jp/en-latest-detail/jRCTs031210593).
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Affiliation(s)
- Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoka Okano
- Department of Pharmacy, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Tomoe Mashiko
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center, Tokyo, Japan
| | - Miyuki Kurosaki
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center, Tokyo, Japan
| | - Tempei Miyaji
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center, Tokyo, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Imai T, Morita S, Hasegawa K, Goto T, Katori Y, Asada Y. Postoperative serum interleukin-6 level as a risk factor for development of hyperactive delirium with agitation after head and neck surgery with free tissue transfer reconstruction. Auris Nasus Larynx 2023:S0385-8146(23)00023-8. [PMID: 36754686 DOI: 10.1016/j.anl.2023.01.005] [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: 07/04/2022] [Revised: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Occurrence of hyperactive postoperative delirium (POD) with agitation after head and neck surgery with free tissue transfer reconstruction (HNS-FTTR) is associated with the risk of life-threatening complications. The relationships between occurrence of hyperactive POD after HNS-FTTR and inflammatory markers reflecting the surgical stress response, represented by postoperative interleukin-6 levels, are not fully understood. METHODS A retrospective study was conducted on 221 consecutive patients who underwent HNS-FTTR at our department between September 2016 and December 2021. Potential risk factors for POD were examined, including age, operation time, intraoperative blood loss, and postoperative serum levels of blood parameters such as interleukin-6, C-reactive protein, and neutrophil-to-lymphocyte ratio. RESULTS Hyperactive POD with agitation was observed in 54 subjects (24.4%). The postoperative hospital stay in the POD group was significantly longer than that in the non-POD group (median: 32.5 days vs. 28 days; p=0.0129). Multivariate logistic regression analysis identified age (in years) (odds ratio: 1.102; p<0.0001), operation time (min) (odds ratio: 1.004; p=0.0359), and postoperative serum interleukin-6 level (pg/mL) (odds ratio: 1.005; p=0.0384) as significant risk factors for development of POD. In a receiver operating characteristic curve and area under the curve analysis, the cut-off value for postoperative serum interleukin-6 level to predict POD development was 82.5 pg/mL. The postoperative serum interleukin-6 ≥82.5 pg/mL group developed hyperactive POD with agitation significantly more often than the postoperative serum IL-6 <82.5 pg/mL group (odds ratio: 4.400; p<0.0001). The postoperative serum IL-6 ≥82.5 pg/mL group also had significantly longer postoperative hospital stay (41.58 ± 33.42 days vs. 31.73 ± 22.89 days; p=0.0151), older age (68.60 ± 9.99 years vs. 64.30 ± 12.58 years; p=0.0054), and longer operation time (625.4 ± 114.05 min vs. 575.5 ± 98.73 min; p=0.0009) than the postoperative serum IL-6 <82.5 pg/mL group. CONCLUSION Postoperative serum interleukin-6 level, as well as age and operation time, were identified as significant independent risk factors for development of hyperactive POD with agitation after HNS-FTTR. Inflammation is a potential target for the prevention and treatment of POD after HNS-FTTR.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
| | - Sinkichi Morita
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Kohsei Hasegawa
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 2-1 Seriryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
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Shen C, Pu Q, Che G. Commentary: Preoperative neutrophil to lymphocyte ratio predicts complications after esophageal resection that can be used as inclusion criteria for enhanced recovery after surgery. Front Surg 2022; 9:1016196. [PMCID: PMC9634404 DOI: 10.3389/fsurg.2022.1016196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
- Correspondence: Guowei Che
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Clinical assessment of early mobilization after head and neck free flap reconstruction: A retrospective case–control study. J Plast Reconstr Aesthet Surg 2022; 75:3997-4002. [DOI: 10.1016/j.bjps.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022]
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Galmiche A, Saidak Z, Bettoni J, Ouendo M, Testelin S. Therapeutic Perspectives for the Perioperative Period in Oral Squamous Cell Carcinoma (OSCC). FRONTIERS IN ORAL HEALTH 2022; 2:764386. [PMID: 35088056 PMCID: PMC8787059 DOI: 10.3389/froh.2021.764386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022] Open
Abstract
The perioperative period is the relatively short window of time, usually measured in days or weeks, around the surgical procedure. Despite its short duration, this time period is of great importance for cancer patients. From a biological point of view, the perioperative period is complex. Synchronous with primary tumor removal, surgery has local and distant consequences, including systemic and local inflammation, coagulation and sympathetic activation. Furthermore, the patients often present comorbidities and receive several medical prescriptions (hypnotics, pain killers, anti-emetics, hemostatics, inotropes, antibiotics). Because of the complex nature of the perioperative period, it is often difficult to predict the oncological outcome of tumor resection. Here, we review the biological consequences of surgery of Oral Squamous Cell Carcinoma (OSCC), the most frequent form of primary head and neck tumors. We briefly address the specificities and the challenges of the surgical care of these tumors and highlight the biological and clinical studies that offer insight into the perioperative period. The recent trials examining neoadjuvant immunotherapy for OSCC illustrate the therapeutic opportunities offered by the perioperative period.
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Affiliation(s)
- Antoine Galmiche
- EA7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
- Service de Biochimie, Centre de Biologie Humaine, Centre Hospitalier Universitaire (CHU) Amiens, Amiens, France
- *Correspondence: Antoine Galmiche
| | - Zuzana Saidak
- EA7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
- Service de Biochimie, Centre de Biologie Humaine, Centre Hospitalier Universitaire (CHU) Amiens, Amiens, France
| | - Jérémie Bettoni
- EA7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Universitaire (CHU) Amiens, Amiens, France
| | - Martial Ouendo
- EA7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Amiens, Amiens, France
| | - Sylvie Testelin
- EA7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Universitaire (CHU) Amiens, Amiens, France
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Chang CWD, McCoul ED, Briggs SE, Guardiani EA, Durand ML, Hadlock TA, Hillel AT, Kattar N, Openshaw PJM, Osazuwa-Peters N, Poetker DM, Shin JJ, Chandrasekhar SS, Bradford CR, Brenner MJ. Corticosteroid Use in Otolaryngology: Current Considerations During the COVID-19 Era. Otolaryngol Head Neck Surg 2021; 167:803-820. [PMID: 34874793 DOI: 10.1177/01945998211064275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. DATA SOURCES PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. REVIEW METHODS Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19-specific findings. CONCLUSIONS Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. IMPLICATIONS FOR PRACTICE SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.
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Affiliation(s)
- C W David Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Marlene L Durand
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nrusheel Kattar
- Department of Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | | | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Imai T, Saijo S, Fujii K, Nakazato A, Nakamura K, Miyakura Y, Yamazaki T, Goto T, Asada Y. Early enteral nutrition after head and neck surgery with free tissue transfer reconstruction. Auris Nasus Larynx 2021; 49:141-146. [PMID: 34218974 DOI: 10.1016/j.anl.2021.06.004] [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: 03/22/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Early enteral nutrition is essential for enhancing recovery after surgery. However, to date, no detailed study has been conducted on the feasibility of early enteral nutrition in patients undergoing head and neck surgery with free tissue transfer reconstruction (HNS-FTTR) and the risk factors for difficulty with early enteral nutrition. METHODS We retrospectively analyzed 102 patients who underwent HNS-FTTR at our institution; 61 underwent free jejunal reconstruction (FJ) and 41 did not. We investigated the achievement of early enteral nutrition within 24 and 48 h after surgery and the discontinuation of enteral nutrition after its initiation within 7 days after surgery. RESULTS Enteral nutrition could be started in 81/102 (79.4%) and 99/102 (97.1%) patients within 24 and 48 h, respectively. Cases of difficulty with early enteral nutrition accounted for 21/102 (20.6%) patients. The multivariate analysis revealed that FJ was a significant independent risk factor for difficulty with early enteral nutrition (odds ratio: 4.054, P = 0.042). The risk factors for difficulty with early enteral nutrition in patients who underwent FJ were also investigated, and the multivariate analysis showed that blood loss of ≥158 mL was a significant independent risk factor (odds ratio: 3.505, P = 0.044). CONCLUSIONS Early enteral nutrition seemed to be provided with no problems in patients without FJ. FJ was a significant risk factor for difficulty with early enteral nutrition. Increased intraoperative blood loss was a significant risk factor for difficulty with early enteral nutrition in patients undergoing FJ; therefore, patients' abdominal symptoms and gastric residual volume should be carefully monitored in such cases.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
| | - Satoshi Saijo
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Keitaro Fujii
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Akira Nakazato
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Kazuki Nakamura
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Yuya Miyakura
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Tomoko Yamazaki
- Department of Head and Neck Medical Oncology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
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12
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Twomey R, Matthews TW, Nakoneshny SC, Schrag C, Chandarana SP, Matthews J, McKenzie D, Hart RD, Li N, Dort JC, Sauro KM. From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction. Cancers (Basel) 2021; 13:2890. [PMID: 34207711 PMCID: PMC8228478 DOI: 10.3390/cancers13122890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
One of the foundational elements of enhanced recovery after surgery (ERAS) guidelines is early postoperative mobilization. For patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction, the ERAS guideline recommends patients be mobilized within 24 h postoperatively. The objective of this study was to evaluate compliance with the ERAS recommendation for early postoperative mobilization in 445 consecutive patients who underwent HNC surgery in the Calgary Head and Neck Enhanced Recovery Program. This retrospective analysis found that recommendation compliance increased by 10% despite a more aggressive target for mobilization (from 48 to 24 h). This resulted in a decrease in postoperative mobilization time and a stark increase in the proportion of patients mobilized within 24 h (from 10% to 64%). There was a significant relationship between compliance with recommended care and time to postoperative mobilization (Spearman's rho = -0.80; p < 0.001). Hospital length of stay was reduced by a median of 2 days, from 12 (1QR = 9-16) to 10 (1QR = 8-14) days (z = 3.82; p < 0.001) in patients who received guideline-concordant care. Engaging the clinical team and changing the order set to support clinical decision-making resulted in increased adherence to guideline-recommended care for patients undergoing major HNC surgery with free flap reconstruction.
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Affiliation(s)
- Rosie Twomey
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - T Wayne Matthews
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - Christiaan Schrag
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Shamir P Chandarana
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Jennifer Matthews
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - David McKenzie
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Robert D Hart
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Na Li
- Department of Community Health Sciences, Surgery & Oncology, University of Calgary Cumming School of Medicine, 3D10, 3280 Hospital Drive NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - Joseph C Dort
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Department of Community Health Sciences, Surgery & Oncology, University of Calgary Cumming School of Medicine, 3D10, 3280 Hospital Drive NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - Khara M Sauro
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Community Health Sciences, Surgery & Oncology, University of Calgary Cumming School of Medicine, 3D10, 3280 Hospital Drive NW Calgary, Calgary, AB T2N 4Z6, Canada
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13
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Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction. Cancers (Basel) 2021; 13:cancers13122852. [PMID: 34201003 PMCID: PMC8227616 DOI: 10.3390/cancers13122852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary For patients diagnosed with head and neck cancer (HNC), surgery to remove the tumour is a standard treatment. The surgery is complex-in most cases, the mouth and throat need to be rebuilt using tissue from another area of the body to restore appearance and function. Recovery from HNC surgery is challenging, and complications occur frequently. It is recommended that patients get out of bed and move (are “mobilized”) as early as possible after surgery (within 24 h) to improve recovery. However, evidence for this recommendation mainly comes from other types of cancer. Therefore, this study investigated whether early mobilization impacts recovery in patients undergoing HNC surgery. We found that delaying mobilization (after 24 h) was linked with more complications and a longer stay in the hospital. Helping patients mobilize within 24 h after HNC surgery should be a priority for healthcare teams. Abstract Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16–2.57) and more major complications (OR = 1.76; 95% CI = 1.00–3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10–6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41–5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.
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