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6th ICHNO
page 63
6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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(42.2%), 2 times in 28 patients (20.8%) and 3 times in 6
patients (4.4%).
Patients who received EN before treatment were
respectively: 2 in the S group (mean length (SD): 2 (1.4)
days), 1 in the RT group (mean length: 43 days), 1 in the
CT group (mean length 47 days), 7 in the RTCT group
(mean length (SD): 14.7 (12) days), 5 in the IND group
(mean length (SD): 25.8 (14) days). Pretreatment EN was
received by no patient in the surgery +RT and surgery
+RTCT groups.
Regarding the post treatment period, the number of
patients having received EN is: 20 in the S group (mean
length (SD): 42.3 (59) days), 4 in the RT group (mean
length (SD): 72 (14) days), 1 in the CT group (mean length
53 days), 22 in the RTCT group (mean length (SD): 102.7
(93) days), 15 in the IND group (mean length (SD): 103.4
(100) days), 8 in the surgery +RT group (mean length (SD):
32 (30) days) and 20 in the surgery +RTCT group (mean
length (SD): 70.5 (110) days). Some patients always
beneficiated from EN 18 months after treatment start.
Conclusion
Enteral nutrition seems necessary during the post
treatment period in 66.7% of patients, whatever the type
of treatment received.
Poster: Minimal invasive and reconstructive surgery
PO-131 Resecting the carotid artery for invasive head
and neck cancer: Time to reconsider its feasibility
A. Jones
1
, C. Daultry
2
, J.C. Wilton
1
1
University of Birmingham, Medical School, Birmingham,
United Kingdom
2
Queen Elizabeth Hospital, ENT, Birmingham, United
Kingdom
Purpose or Objective
Head and cancer invading the carotid artery poses a
difficult question for the clinician as the optimum
management strategy is unclear. What is known is that
carotid artery involvement is a poor prognostic indicator
with survival rates ranging from 0% to 35% at 1 to 2
years. The surgical options include peeling the tumour
from the carotid artery adventitia, performing en bloc
resection and ligation of the carotid artery, or en bloc
resection followed by reconstruction of the carotid
artery. Aims: Does survival time improve with surgery
compared with chemoradiotherapy (CRT)? If so, does the
survival benefit outweigh the risks of surgery? When
surgery has been decided upon, what is the most effective
method of resection and should reconstruction of the
carotid artery be attempted?
Material and Methods
This review reflected upon the major historical papers and
provides an in-depth analysis of research over the last 10
years pertaining to the management of malignant carotid
invasion.
Results
Survival outcomes are presented in Table 1. Okamoto et
al reported 100% mortality at 8 months of patients who did
not undergo surgical intervention and no patients survived
longer than 15 months who underwent CRT within the
series by Roh et al. The evidence suggests that with
careful selection of patients, surgical management can
improve survival outcomes and may be the only solution
to achieve long term survival.
Following 401 surgical procedures involving the carotid
artery, 14 patients suffered strokes (3.49%) and 22
patients (5.49%) suffered carotid blowouts. Zhengang et al
do not provide peri-operative mortality data; as such their
series is removed from the overall post-operative stroke
or death rate calculation. Therefore, following 328
procedures, 5 patients (1.52%) died within the post-
operative period and 15 patients (4.57%) suffered major
stroke or death in the post-operative period.This is an
improvement from outcomes described by the meta-
analysis of Snyderman et al, who found carotid resections
were complicated by major neurological deficit in 16.7%
of patients.
Rates of post-operative stroke did not differ between
patients that underwent tumour peel and those that
underwent resection and reconstruction (p = 0.76). Whilst
rates of carotid blowout syndrome were greater than
twice as high within the tumour peel group, the results
were
not
significant
(p
=
0.11).
The evidence pertaining to oncological outcomes weighs
in favour of performing resection and reconstruction, as
opposed to performing tumour peel.
Conclusion
When considering the available evidence, the best
oncological outcomes are most likely achieved by centres
performing carotid resection and reconstruction. It can
also be seen that outcomes are further improved when
surgery is performed as the primary treatment modality,
in the absence of metastatic lesions. There is also
evidence to suggest that performing resection and
reconstruction may reduce the risk of carotid blowout
syndrome compared with tumour peel.
PO-132 Risk of re-operation for bleeding in head and
neck surgery.
E. Haapio
1
, I. Kinnunen
1
, J. Airaksinen
2
, H. Irjala
1
, T.
Kiviniemi
2
1
Turku University Central Hospital, Otorhinolaryngology,
Turku,
Finland
2
Turku University Central Hospital, Heart center, Turku,
Finland
Purpose or Objective
Intraoperative bleeding complicates the identification of
crucial structures in head and neck area and is potentially
fatal. We conducted a retrospective study to assess head
and neck cancer (HNC) operations which carry high risk
factors for re-operation due to postoperative bleeding.
Material and Methods
Study included a total of 456 patients (591 operations)
who underwent surgery for HNC between 1999-2008 in
tertiary care center of Turku University Hospital. Need of
re-operation for bleeding was evaluated.
Results
Data on intraoperative bleeding was available in 265
operations. Median estimated intraoperative bleeding was
700mL [IQR 800] and operations with ≥ 700ml bleeding
were defined as high bleeding risk operations. High
bleeding risk operations included surgery with
microvascular reconstruction or reconstruction using
pedicled regional flap, salivary gland operation with neck
dissection and major sinonasal surgery. Moreover, high
bleeding risk operations were associated with increased
risk for re-operation due to postoperative bleeding
(p=0.001). Other risk factors for re-operation because of
postoperative bleeding were history of heavy alcohol
consumption (p=0.014), preoperative oncologic treatment
(p=0.017), higher tumor stage (p=0.020), higher T-
classification (p=0.034) and over 4000ml fluid
administration within the operation day (24h) (p>0.001).
Re-operation for bleeding was an independent risk factor
for 30-day mortality after operation (p=0.014).
Conclusion
High bleeding risk operation, heavy alcohol consumption,
preoperative oncologic treatment, higher tumor stage and