Free Tissue Transfers for Head and Neck Cancer Patients with End Stage Renal Disease on Dialysis: Analysis of Outcomes using the Taiwan’s National Health Insurance Research Database
Oscar J. Manrique, MD1, Pedro Ciudad, MD, PhD2, Jorys Martinez-Jorge, MD1, Steven Moran, MD1, Samir Mardini, MD1, Hung-Chi Chen, MD, PhD2, Hsu-Tan Cheng, MD2.
1Mayo Clinic, Rochester, MN, USA, 2China Medical University Hospital, Taichung, Taiwan.
PURPOSE: End-stage renal disease patients are increasing at around 5% annually. Success rates of free-tissue transfer have been reported between 95 and 99%. Comorbidities, such as uremia, diabetes mellitus and atherosclerotic disease, can increase the level of complexity. We describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head/neck reconstruction.
METHODS: Based on the Taiwan national insurance database, two-cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group. Postoperative complications within 90-days and mortality within 30-days of the date of surgery were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD).
RESULTS: Between 1998-2010, 85 cases with ESRD on dialysis and 841 controls without ESRD were analyzed. Majority of patients were aged ≦65 years (82.5%) and 92.9% were men. The major subdivision of head/neck cancer was neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gum, hypopharynx and floor of mouth. ESRD patients tended to have higher rates of DM and PVD (p<0.001). They also were significantly associated with an increased risk of stroke (adjusted OR=4.28, 95% CI=1.30-14.1) and a significantly increased risk of 30-day mortality (adjusted OR=4.58, 95% CI=1.18-17.8). However, there was no significant difference regarding flap failure among groups (adjusted OR=0.74, 95% CI=0.27-2.05).
CONCLUSION: Despite greater pre-operative risk factors, renal failure does not appear to effect free flap survival following head and neck reconstruction. Optimizing patient’s medical condition is critical to the success of this reconstructive effort.
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