title: The impacts of liver cirrhosis on head and neck cancer patients undergoing microsurgical free tissue transfer: an evaluation of flap outcome and flap-related complications.
abstract: Several authors have cited liver cirrhosis as a risk factor for surgery but no study performed statistical correlation between flap outcome and severity of liver cirrhosis in patients with head and neck cancer. We performed a retrospective analysis of 3108 patients who underwent free tissue transfer after head and neck cancer ablation between January 2000 and December 2008. Liver cirrhosis was identified in 62 patients. Forty-two patients (67.7%) were classified as having Child's class A cirrhosis, seventeen (27.4%) as having class B, and three (4.9%) as having class C cirrhosis. The overall complete flap survival rate was 90.3% (56/62). The flap-related complications of patients with Child's class A, B, and C were 38.1% (16/42), 47.1% (8/17), and 100% (3/3), respectively and showed no significant difference between these three groups (p=0.2758). The rate of postoperative neck hematoma was 14.5%; the risk of postoperative neck hematoma was significantly higher in patients with more advanced liver cirrhosis (p=0.0003). The recipient-site complications of patients with Child's class A cirrhosis, Child's class B, and Child's class C cirrhosis were 35.7%, 41.1%, and 66.6%, respectively, with no significant difference among the three groups. The statistical analysis demonstrated that diabetes mellitus is significantly associated with a negative prognosis for free flap reconstruction (p=0.0364). The flap survival rate and patency of microvascular anastomosis have no association with liver cirrhosis. To achieve a superior surgical outcome, preoperative optimization and a multidisciplinary team responsible for the evaluation and treatment of head and neck cancer patients with cirrhosis are necessary.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 5 Fu-Hsing Street, Kuei-Shan, Taoyuan, Taiwan.
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Wei-Cheng
authors.initials: WC
authors.lastname: Ching
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006085:Graft Survival / Q000502:physiology; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery*; D006406:Hematoma / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009333:Neck; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome