ABSTRACT
BACKGROUND: The purpose of this study was to present our systematic review and meta-analysis of the data on venous thromboembolism (VTE; deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in otolaryngology-head and neck surgery (OHNS). METHODS: PubMed and Scopus databases were searched for studies reporting VTE in OHNS. Incidence of VTE and bleeding is reported and meta-analyzed overall and for chemoprophylaxis and squamous cell carcinoma (SCC)/free flap subgroups. RESULTS: A total of 23 studies were included with a total of 618,264 patients. Incidence of VTE was 0.4%. The incidence of bleeding complications was 0.9%. The addition of chemoprophylaxis did not result in a decreased VTE incidence (odds ratio [OR], 0.86), but produced an increased risk of bleeding (OR, 3.78). The overall OR for VTE in SCC/free flap cases was 6.28. CONCLUSION: Chemoprophylaxis may not be necessary in the OHNS non-SCC or free flap patient population and must be balanced against an increased risk of bleeding. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1249-1258, 2017.
Subject(s)
Otorhinolaryngologic Neoplasms/surgery , Otorhinolaryngologic Surgical Procedures/adverse effects , Pulmonary Embolism/epidemiology , Venous Thromboembolism/epidemiology , Disease-Free Survival , Female , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Incidence , Male , Otorhinolaryngologic Diseases/pathology , Otorhinolaryngologic Diseases/surgery , Otorhinolaryngologic Neoplasms/diagnosis , Otorhinolaryngologic Surgical Procedures/methods , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Prognosis , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Risk Assessment , Survival Analysis , Venous Thromboembolism/etiology , Venous Thromboembolism/physiopathologyABSTRACT
OBJECTIVES/HYPOTHESIS: Although salvage total laryngectomy remains the definitive approach to recurrent/persistent glottic cancer following failed radiation therapy for favorable early-stage disease, it comes at the price of a permanent laryngostome and an impact on quality of life. We describe a three-stage method of laryngeal reconstruction for salvage partial laryngectomy to address the unique challenges of operating on radiation recurrent/persistent cancer. STUDY DESIGN: This was a single-surgeon retrospective case series of patients who underwent a three-stage laryngeal reconstruction for salvage partial laryngectomy. METHODS: We performed a comprehensive review of the clinical, pathologic, and radiologic files of all patients who underwent a three-stage laryngeal reconstruction for salvage partial laryngectomy. RESULTS: Seven male patients underwent a three-stage laryngeal reconstruction following open partial salvage laryngectomy. The average follow-up time since salvage surgery was 55 months. All patients were without evidence of recurrence and demonstrated satisfactory functional outcomes. CONCLUSION: Staged reconstruction provides a more controlled assessment of wound healing and valuable pathologic information regarding the specific disease virulence and adequacy of the margins. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1061-1070, 2016.
