Impact of intraoperative fluid administration on associated outcomes in head and neck cancer free flap surgery at a tertiary care hospital

Objective Bioselection to assess tumor response after induction chemotherapy has been introduced as an alternative treatment strategy to total laryngectomy for patients with advanced larynx squamous cell carcinoma (LSCC). Tumor-infiltrating lymphocytes (TILs) have proven to serve as prognostic biomarkers in head and neck cancer but have not been evaluated as a way to select patients for treatment paradigms. The aim of this study is to evaluate the role of pretreatment TILs in patients with advanced LSCC undergoing the bioselection paradigm. Study Design Retrospective study. Setting Tertiary care hospital. Methods Patients with advanced LSCC treated with bioselection and available tissue were included (N = 76). Patients were stratified into CD8-low and CD8-high cohorts by using the median TIL count. Kaplan-Meier survival analysis and multivariate cox regression were performed with SPSS version 26 (IBM). Results After controlling for tobacco use, tumor site, and stage, a high CD8 TIL count was an independent predictor of improved 5-year disease-specific survival (hazard ratio, 0.17 [95% CI, 0.03-0.84]; P = .03). CD8 TIL counts did not predict response to induction chemotherapy; however, subgroup analysis of patients treated with chemoradiation therapy revealed that CD8 TIL count was significantly associated with degree of response ( P = .012). Conclusion These findings support prior data published by our group showing that TILs are predictive of disease-specific survival in patients with head and neck cancer. CD8 TIL counts were significantly associated with degree of clinical response after induction chemotherapy. These results suggest that pretreatment assessment of tumor-infiltrating CD8 cells could be useful in selecting patients.

Download Full-text

You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215116000037 ◽

2016 ◽

Vol 130 (3) ◽

pp. 278-283 ◽

Cited By ~ 11

Author(s):

A Ghosh ◽

G Philiponis ◽

A Bewley ◽

E R Ransom ◽

N Mirza

Keyword(s):

Smoking Cessation ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Financial Incentives ◽

Past History ◽

Tertiary Care ◽

High Risk Population ◽

Care Hospital ◽

Incentive Group

AbstractObjective:A prospective randomised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population.Methods:Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period. They were randomised to a cash incentives or no incentive group. Subjects were offered enrolment in smoking cessation courses. Smoking by-product levels were assessed at 30 days, 3 months and 6 months. Subjects in the incentive group received $150 if smoking cessation was confirmed.Results:Over 2 years, 114 patients with an established diagnosis of head and neck cancer were offered enrolment. Twenty-four enrolled and 14 attended the smoking cessation classes. Only two successfully quit smoking at six months. Both these patients were in the financially incentivised group and received $150 at each test visit.Conclusion:Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful.

Download Full-text

Comparison of Open Gastrostomy and Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients, Tertiary Care Hospital Experience

National Journal of Health Sciences ◽

10.21089/njhs.54.0166 ◽

2021 ◽

Vol 5 (4) ◽

pp. 166-170

Author(s):

Talha Ahmed Qureshi ◽

◽

Shabir Akhtar ◽

Sohail Awan ◽

Amir Sharif ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Percutaneous Endoscopic Gastrostomy ◽

Neck Cancer ◽

Tertiary Care ◽

Ethical Review ◽

Care Hospital ◽

Endoscopic Gastrostomy ◽

Peristomal Infection

Abstract: Objective: The current study was conducted to review and compare PEG and Gastrostomy in terms of early complications in head and neck cancer patients. Materials and Methods: This was prospective comparative study recruited total 60 patients as per the inclusion criteria, 30 in each group. Patients were assigned to the groups based on the surgeon’s choice. Ethical clearance was taken from ethical review board. Informed consent was taken from patients before enrolling them into the study. Non-probability consecutive sampling technique was used to enroll study participants. Data was collected on pre-designed performa and analyzed using SPSS version 16. Setting: Section of Otolaryngology, Department of Surgery, Aga Khan University Hospital Karachi. Results: The two groups did not differ on basis of age, gender and tumor site. The outcomes variables including pain and bleeding from post-operative day1 to day 5 were significantly lower in patients who underwent PEG placement as compared to patients whom we performed OPEN gastrostomy. None the patient had peristomal infection in PEG group throughout the study. However, difference between the groups was statistically significant from post-operative day 3 to day 5. Conclusion: In our study, PEG was associated with lesser complications than open gastrostomy. Recently clinicians are using newer modalities like radiological and laparoscopic gastrostomy at various centres in Pakistan as the first option for placing feeding gastrostomy. Therefore, future studies are warranted to compare their efficacy and post-operative complications PEG. Keywords: Head and neck cancer, Open gastrostomy, Percutaneous endoscopic gastrostomy, Complications, Pain, Peristomal infection, Bleeding

Download Full-text

NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

OTO Open ◽

10.1177/2473974x16685692 ◽

2017 ◽

Vol 1 (1) ◽

pp. 2473974X1668569 ◽

Cited By ~ 5

Author(s):

Charles A. Riley ◽

Blair M. Barton ◽

Claire M. Lawlor ◽

David Z. Cai ◽

Phoebe E. Riley ◽

...

Keyword(s):

Length Of Stay ◽

Head And Neck ◽

Free Flap ◽

Reconstructive Surgery ◽

Tertiary Care ◽

Case Series ◽

Flap Surgery ◽

Improvement Program ◽

Free Flap Surgery ◽

The Mean

Objective The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses. Methods A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator. Results Thirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days ( P = .027). Discussion The NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population. Implications for Practice: Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.

Download Full-text