Complications encountered in a prospective series of 182 patients treated surgically for mouth cancer

McGurk, Mark; Fan, K F M; MacBean, Andrew; Putcha, Venkata

doi:10.1016/j.oraloncology.2006.04.017

Cited by 23 publications

(18 citation statements)

References 9 publications

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“…The significant effect of comorbidities on the development of complications has been consistent across many other studies, 20,24,25,27,28,30,31 as well. Other studies 1,25,29 also confirmed our finding that older age was associated with increasing rates of postoperative complications.…”

Section: Discussionsupporting

confidence: 84%

“…Other studies have also found that greater procedure complexity increased a patient’s risk of developing complications, including neck dissection, 17,20,21 reconstruction, 20,22,23 and tracheotomy. 24,25 Surrogate operative markers of procedure complexity also increased this risk, including anesthesia time, 26–28 volume of intraoperative fluid administered, 26,29 and estimated blood loss. 20 We included anesthesia time as a representative marker of surgical operative complexity, and this strongly correlated with positive fluid balance ( R 2 = 0.76), which was therefore not included in our model.…”

Section: Discussionmentioning

confidence: 99%

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Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

Awad

Palmer

Kou

et al. 2015

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging. OBJECTIVE To develop a statistical tool capable of predicting an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012. MAIN OUTCOMES AND MEASURES The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III–V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram. RESULTS Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count, preoperative hematocrit, planned neck dissection, and planned tracheotomy. The nomogram predicted a major complication with a validated concordance index of 0.79. Inclusion of surgical operative variables in the nomogram maintained predictive accuracy (concordance index, 0.77). CONCLUSIONS AND RELEVANCE A statistical tool was developed that accurately estimates an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

Awad

Palmer

Kou

et al. 2015

JAMA Otolaryngol Head Neck Surg

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“…It is widely accepted that patients with locoregionally advanced tumours (UICC (international union against cancer) disease stages III and IV) and resectable primary tumours benefit from combined treatment modalities with surgery, radiotherapy (RT) and chemotherapy (CT) (Mohr et al, 1994;McGurk et al, 2007;Preuss et al, 2007). Yet there is no consensus whether RT and CT should be administered before or after surgery .…”

Section: Introductionmentioning

confidence: 99%

Preoperative radiochemotherapy in the treatment of advanced oral cancer: Outcome of 276 patients

Klug¹,

Berzaczy²,

Voracek³

et al. 2009

Journal of Cranio-Maxillofacial Surgery

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“…Borggreven et al [15] reported that the comorbidity grade was a predictor of post-operative complications in head and neck cancer patients who had been treated surgically. Moreover, McGurk et al [2] reported that patients with pre-existing cardiovascular disease had a 1.5-fold greater risk of developing major (life-threatening) and intermediate (hospital-stay-prolonging) post-operative complications, while patients with respiratory disease had a 1.8-fold greater risk of developing major and intermediate post-operative complications. Ferrier et al [22] operated on 117 head and neck cancer patients whose comorbidities were graded according to ACE-27 (41%, Grade 0; 29.9%, Grade 1; 29.1%, Grade 2 or 3), and 21.4% of the patients in their series had major complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, many head and neck cancer patients are older people and have significant medical comorbidities [1]. Pre-treatment comorbidities, such as cardiovascular and respiratory disease, sometimes impair patients' post-operative recovery, and patients with severe comorbidity have an increased risk of operative death or death from head and neck cancer [2].…”

mentioning

confidence: 99%

Disease control using low-dose-rate brachytherapy is unaffected by comorbid severity in oral cancer patients

Yoshimura

Shibuya²,

Hayashi³

et al. 2011

BJR

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Objective: The aim of this study was to evaluate the outcome and complications of low-dose-rate brachytherapy (LDR-BT) for oral cancer according to comorbidity. Methods: The records of a total of 180 patients who received LDR-BT for T1-2N0M0 oral cancers between January 2005 and December 2007 were analysed. The comorbidities of the patients were retrospectively graded according to the Adult Comorbidity Evaluation-27, and the relationships between the comorbidity grades and survival, disease control and the incidence of complications were analysed. Results: The 2 year overall survival rates of patients with no comorbidity, Grade 1, Grade 2 and Grade 3 comorbidity were 87%, 85%, 76% and 65%, respectively, and the reduction in the survival rate according to comorbid severity was significant in a univariate analysis (p50.032) but not in a multivariate analysis including other clinical factors. Cause-specific survival, locoregional control and local control were not related to the comorbidity grade, or any other clinical factors. Grade 2 or 3 complications developed in 27% of the patients. The incidence of complications was unrelated to the comorbidity grade. Conclusion: The disease control of oral cancer and the incidence of complications after LDR-BT were not related to comorbid severity. LDR-BT is a useful and safe treatment for patients regardless of the presence of severe comorbidity.

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Complications encountered in a prospective series of 182 patients treated surgically for mouth cancer

Cited by 23 publications

References 9 publications

Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

Preoperative radiochemotherapy in the treatment of advanced oral cancer: Outcome of 276 patients

Disease control using low-dose-rate brachytherapy is unaffected by comorbid severity in oral cancer patients

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