Abstract
Smoking is an important risk factor in the development of head and neck cancer. However, little is known about its effects on postoperative complications in head and neck cancer surgery. We performed a retrospective analysis on 535 consecutive laryngeal cancer patients submitted to open partial laryngectomy at the Otolaryngology-Head and Neck Surgery Department of Florence University to evaluate a possible correlation between smoking and surgical complications. Patients were grouped in non smokers and smokers and evaluated for airway, swallowing, local and fistula complications by multivariate analysis: 507 (95%) patients were smokers, 69% presented supraglottic, 30% glottic and 1% transglottic cancer. The most common operation was supraglottic horizontal laryngectomy in 58%, followed by supracricoid partial laryngectomy in 27% and frontolateral hemilaryngectomy in 15% of cases. The incidence of overall complications was 30%, airway complications representing the most frequent (14%), followed by swallowing (7%), local (6%) and fistula complications (3%). Smokers developed more local complications (p = 0.05, univariate, p = 0.04, multivariate analysis) and pharyngocutaneous fistula (p = 0.01, univariate, p = 0.03, multivariate analysis).
Highlights
Smoking is the most important risk factor in head and neck cancer [1]
Head and neck cancer treatment often includes a combination of surgery, radiotherapy and chemotherapy, which increase the difficulty of wound healing, especially in a population with a mean age of 60 years, with a higher incidence of comorbidities and a preoperative debilitated physical state [13,14]
We focused on a series of consecutive patients submitted to conservative laryngeal surgery, in order to analyze the impact of smoke on wound healing in this specific subgroup, and define possible risk factors responsible for the onset of postoperative complications
Summary
Smoking is the most important risk factor in head and neck cancer [1]. According to a large case-control study, over 90% of laryngeal cancer cases in Southern Europe could be prevented by avoiding smoking [2]. Tobacco exposure represents a risk factor for the development of perioperative surgical complications [11]. Head and neck cancer treatment often includes a combination of surgery, radiotherapy and chemotherapy, which increase the difficulty of wound healing, especially in a population with a mean age of 60 years, with a higher incidence of comorbidities and a preoperative debilitated physical state [13,14]. We focused on a series of consecutive patients submitted to conservative laryngeal surgery, in order to analyze the impact of smoke on wound healing in this specific subgroup, and define possible risk factors responsible for the onset of postoperative complications
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