Abstract
ObjectiveTo evaluate the changes of serum albumin levels during the peri-operative period, and correlate these changes to surgical outcomes, postoperative morbidity and mortality in head and neck cancer patients with cirrhosis.Methods57 patients with liver cirrhosis out of 3,022 patients who underwent immediate free flap reconstruction after surgical ablation of head and neck cancer performed over a 9-year period were included in the study. Two sets of groups were arranged based on the preoperative albumin (>3.5 g/dL vs. ≤ 3.5 g/dL) and POD1 albumin (>2.7 g/dL vs. ≤ 2.7 g/dL) levels and were compared with respect to patient-related variables, surgical outcomes, medical and surgical complications, and mortalities.ResultsAll patients had significant decreases in albumin levels postoperatively. Hypoalbuminemia, both preoperative and postoperative, was associated with the model for end-stage liver disease (MELD) score, the amount of blood loss, the duration of ICU stay and hospital stay, and postoperative medical and surgical complications. In particular, preoperative hypoalbuminemia (serum albumin ≤ 3.5 g/dL) was associated strongly with medical complications and mortality, while postoperative hypoalbuminemia (serum albumin ≤ 2.7 g/dL) with surgical complications.ConclusionOur study demonstrated the prognostic values of albumin levels in head and neck cancer patient with liver cirrhosis. The perioperative albumin levels can be utilized for risk stratification to potentially improve surgical and postoperative management of these challenging patients.
Highlights
Medical conditions such as malnutrition, cancer, advanced age, and other preexisting diseases all contribute to hypoalbuminemia
Comparisons of Patients Based on Preoperative and postoperative day 1 (POD1) Serum Albumin Concentrations
Comparisons of patient demographics and operative variables based on preoperative albumin (.3.5 g/dL vs. # 3.5 g/dL) and POD1 albumin (.2.7 g/dL vs. # 2.7 g/dL) concentrations are presented in Table 1 and 2, respectively
Summary
Medical conditions such as malnutrition, cancer, advanced age, and other preexisting diseases all contribute to hypoalbuminemia. Due to the location involving the upper digestive tract, the patients with head and neck cancer are among the most malnourished of cancer patients, with the reported prevalence up to 35–50% [1,2]. Malnutrition and hypoalbuminemia are common findings in patients with liver cirrhosis. In patients with head and neck cancer and concomitant liver cirrhosis, hypoalbuminemia is even more aggravated and presents a challenging issue that warrants further workup and management. The incidence of liver cirrhosis among head and neck cancer patients in Taiwan was 2% during a 9-year follow-up period [3]. Head and neck cancer patients with liver cirrhosis may be at an even greater risk of malnutrition that adversely affect surgical outcomes because of greater disease severity and comorbidity than the individual disease only
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