title: Operative Nd:YAG laser plus postoperative hyperbaric oxygen reduces surgical morbidity after radical head and neck cancer surgery and complex reconstruction.
abstract: Complications after radical head and neck cancer surgery in irradiated patients are frequent and life-threatening. Hemorrhage, salivary fistulas, wound infections that expose the carotid sheath, among others, make these patients difficult management challenges in the ICU. We studied the effects of Nd:YAG laser surgery plus hyperbaric oxygen (HBO2) therapy on radical head and neck resections and complex reconstruction as a means of reducing postoperative morbidity and mortality.
  
  
  METHODS
  43 head and neck cancer patients were reviewed. Eight (STD) had standard surgery; 35 (YAG:HBO2) had Nd:YAG laser and postoperative HBO2.
  
  
  RESULTS
  Age, staging, primary tumor site, sex, reconstruction procedure and transfusion did not differ between STD and YAG/HBO2. All STD and Nd:YAG/HBO2 patients were irradiated, median dosages 5,000 centi-Gray (cGy) and 7,000 cGy, respectively (p = 0.073). Median blood loss was 1,000 ml STD and 700 ml YAG/HBO2 (p = 0.046). There were no postoperative deaths. Major surgical site complications developed in 63% of the STD and 17% of the YAG/HBO2 patients (p = 0.017). All STD and 62% of YAG/HBO2 cancers recurred within 28 months of surgery (p = 0.152). Within the STD and YAG/HBO2 groups, 100% and 77% of deaths, respectively, were due to cancer.
  
  
  CONCLUSIONS
  Combined Nd:YAG laser surgery and HBO2 reduces morbidity in radical head and neck cancer surgery. Recurrent disease and poor cancer survival remain common in this high-risk population.
authors: Department of Surgery, UMDNJ/Robert Wood Johnson Medical School at Camden, Camden, NJ, USA. doctorg49@aol.com
authors: Gus J
authors: GJ
authors: Slotman
authors: Martha
authors: M
authors: Matthews
authors: Leilani
authors: L
authors: Fahey
authors: Steven
authors: S
authors: Thom
authors: James
authors: J
authors: Clark
authors: Kevin
authors: K
authors: Hardy
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D006931:Hyperbaric Oxygenation; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies