Postoperative Morbidity and Mortality of Head and Neck Cancers in Patients With Liver Cirrhosis Undergoing Surgical Resection Followed by Microsurgical Free Tissue Transfer

Abstract

The aim of this study was to evaluate the association and the related risk factors between postoperative complications and mortality and the severity of liver cirrhosis in head and neck cancer patients undergoing tumor ablation followed by microsurgical free tissue transfer. Between January 2000 and December 2008, a total of 3108 patients were retrospectively reviewed. The diagnosis of liver cirrhosis was made mainly by abdominal ultrasonography. The Child's classification was used to assess the severity of liver cirrhosis. There were 60 men and 2 women enrolled. Preoperatively, 42, 17, and 3 patients were classified as Child's class A, B, and C, respectively. Class B patients had statistically significantly prolonged stay in the intensive care unit and hospital stay compared to class A patients. Patients with class B or C cirrhosis had more complications than those with class A cirrhosis (80% vs. 19.1%, P < .001). This included significantly increased rates of pulmonary complications, acute renal failure, and sepsis. The mortality rate was also significantly higher for patients with class B/C cirrhosis than for those with class A cirrhosis (30% vs. 4.8%, P = .011). By logistic regression model, preoperative platelet count, intraoperative blood transfusion > or =2 units, and Child's class were found to be significant predictive factors for morbidities. Likewise, Child's class, albumin level, intraoperative blood transfusion > or =2 units, intraoperative blood loss >500 ml, and prothrombin time were significant predictive factors for mortality. Child's class, along with its several components, and intraoperative blood transfusion of > or =2 units are predictive factors for morbidity and mortality.