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Abstract
The aim of this study was to evaluate two practices of airway management in patients undergoing head and neck cancer (HNC) resection and microvascular free tissue transfer (MFTT), and to assess the advantages and disadvantages of the two approaches. Patients undergoing a delayed extubation approach (NO-TRACH group) and patients undergoing primary tracheotomy (PRIM-TRACH group) were retrospectively evaluated in terms of perioperative and postoperative outcome measures. Not performing routine tracheotomy was safe and no perioperative airway complications occurred. NO-TRACH patients were extubated after 1.1 ± 0.9 days (mean ± standard deviation) and secondary tracheotomy was necessary in three patients (13%). NO-TRACH patients revealed decreased duration of surgery (p <0.05) and showed trends to earlier resumption of oral feeding and decreased length of hospitalisation. Flap complication rates were similar in both groups, with an overall flap survival rate of 97.5% (n = 39/40). With appropriate postoperative care, carefully selected patients undergoing major HNC resections with MFTT can be safely managed without routine tracheotomy.
Highlights
Airway management in head and neck cancer (HNC) patients undergoing major surgical procedures, including microvascular free tissue transfer (MFTT), has often been routine tracheotomy
Two patients were excluded from the study because they had pre-existing tracheostomies
Statistical analysis A total of 40 patients met inclusion criteria. They were split into two groups, namely patients with no tracheotomy or secondary tracheotomy (n = 23; NO-TRACH group) and patients with primary tracheotomy (n = 17; PRIM-TRACH group)
Summary
Airway management in head and neck cancer (HNC) patients undergoing major surgical procedures, including microvascular free tissue transfer (MFTT), has often been routine tracheotomy. The necessity of this procedure has, been questioned [1, 2]. Proponents of routine tracheotomy argue that extensive HNC resection combined with MFTT is a major surgical procedure with long operative times and often performed on poly-morbid patients. Laryngopharyngeal oedema, posterior tongue oedema, swelling of the free flap, haemorrhage and phlegm accumulation can all potentially cause airway compromise These concerns are pressing in surgically treated oropharyngeal cancer.
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