title: The roles of albumin levels in head and neck cancer patients with liver cirrhosis undergoing tumor ablation and microsurgical free tissue transfer.
abstract: OBJECTIVE
  To evaluate the changes of serum albumin levels during the peri-operative period, and correlate these changes to surgical outcomes, postoperative morbidity and mortality in head and neck cancer patients with cirrhosis.
  
  
  METHODS
  57 patients with liver cirrhosis out of 3,022 patients who underwent immediate free flap reconstruction after surgical ablation of head and neck cancer performed over a 9-year period were included in the study. Two sets of groups were arranged based on the preoperative albumin (>3.5 g/dL vs. ≤ 3.5 g/dL) and POD1 albumin (>2.7 g/dL vs. ≤ 2.7 g/dL) levels and were compared with respect to patient-related variables, surgical outcomes, medical and surgical complications, and mortalities.
  
  
  RESULTS
  All patients had significant decreases in albumin levels postoperatively. Hypoalbuminemia, both preoperative and postoperative, was associated with the model for end-stage liver disease (MELD) score, the amount of blood loss, the duration of ICU stay and hospital stay, and postoperative medical and surgical complications. In particular, preoperative hypoalbuminemia (serum albumin ≤ 3.5 g/dL) was associated strongly with medical complications and mortality, while postoperative hypoalbuminemia (serum albumin ≤ 2.7 g/dL) with surgical complications.
  
  
  CONCLUSIONS
  Our study demonstrated the prognostic values of albumin levels in head and neck cancer patient with liver cirrhosis. The perioperative albumin levels can be utilized for risk stratification to potentially improve surgical and postoperative management of these challenging patients.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
authors.forename: Wei F
authors.initials: WF
authors.lastname: Chen
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Chen
authors.forename: Victor Bong-Hang
authors.initials: VB
authors.lastname: Shyu
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
mesh_terms: D000328:Adult; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood* / Q000150:complications* / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin