Functional Status to Predict Post-Operative Course in Palliative Head and Neck Reconstructive Surgery
Brian D. Mikolasko, MD, Corin M. Kinkhabwala, BA, Yaacov Y. Chein, BA, Carrie S. Stern, MD, Oren M. Tepper, MD, Thomas J. Ow, MD, Alejandro Conejero, MD, Evan S. Garfein, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Surgical resection and reconstruction may offer significant symptomatic relief to patients with incurable head and neck cancer. It remains unclear which patients receive the greatest palliation at the lowest physiological cost. This study assesses peri-operative complications and post-operative outcomes in patients grouped by functional status to better define which patients benefit most from palliative reconstructive surgery.
A retrospective review of patients undergoing palliative reconstructive surgery from 2008-2014 was performed. Patients were grouped by functional status using Eastern Cooperative Oncology Group (ECOG) scores. Surgery was palliative if the patient had metastatic disease or involvement of the carotid arteries, skull base, prevertebral space, or intracranial space. ECOG scores corresponded to mild (1=no strenuous activity), moderate (2=cannot work), and severe (≥3=mostly bedbound) impairment.
Thirty-four patients with ECOG scores ranging 1-3 underwent palliative reconstruction with 24 free and 11 pedicle flaps. Greater pre-operative functional impairment predicted decreased survival, increased hospitalization as a percent of survival, and increased frequency and severity of systemic and reconstructive complications. Flap survival did not differ between groups.
Patients with ECOG scores of 1 and 2 had a more favorable post-operative course. An ECOG score of 3 was associated with limited survival and a large percentage of time spent hospitalized. Using pre-operative functional status as a predictor of post-operative outcomes, we can better stratify which patients should be offered palliative surgery.
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