Journal of Prevention and Treatment for Stomatological Diseases ›› 2020, Vol. 28 ›› Issue (9): 575-580.doi: 10.12016/j.issn.2096-1456.2020.09.005

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55 cases of perioperative mortality in oral maxillofacial head and neck cancer patients: a retrospective analysis

SUN Zhongyi1(),CHEN Yiming2,WANG Yi3(),JI Tong2()   

  1. 1. Department of Oral and Maxillofacial Surgery, the Central Hospital of JA MU SI City, Jamusi 154002, China
    2. Department of Oral and Maxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai 200011, China
    3. Department of General dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai 200011, China
  • Received:2020-04-12 Revised:2020-05-26 Online:2020-09-20 Published:2020-08-24
  • Contact: Yi WANG,Tong JI E-mail:szy19840302@163.com;realwangyi@sina.com;jitong70@hotmail.com

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Abstract:

Objective To analyze the characteristics of perioperative mortality (POM) in oral maxillofacial head and neck cancer patients.Methods A retrospective study was adapted for head and neck cancer patients who were treated and had POM in the department of oral maxillofacial & head and neck oncology in Shanghai Ninth People′s Hospital from Jan 1999 to Dec 2019. Demographic information, disease characteristic and clinical records were collected. The factors of POM were classified into surgical complication, medical complication, mixed complication (surgical and medical) and personal complication. SPSS 17.0 software was used to analyze the cause composition for POM under different condition.Results 55 patients were included: 39 were male, and 16 were female. A total of 12 patients had a smoking history. Furthermore, 28 patients had general comorbidities. 20 underwent preoperative radiotherapy and 9 received preoperative chemotherapy. Squamous cell carcinoma was the most frequent pathological diagnosis in 37 patients. A total of 9 patients had tumors in the maxilla and skull base. In addtition, 4 patients had POM preoperatively, 1 patient had POM within the operation, and 50 patients had POM postoperatively. The leading causes of death were as follows: rupture of the carotid artery was the most frequent (8), and the surgical complication of pulmonary infection was the main medical complication (6). Pulmonary infection and hemorrhage were regarded as the main mixed complication (4). Two patients had POM due to personal complications. The higher the American Society of Anesthesiologists (ASA) score, the higher the proportion of medical factors in POM (P=0.039).Conclusion The composition of POM in oral maxillofacial- head and neck cancer (OMHNC) patients was complicated. Carotid artery rupture was the most common and fatal surgical complication, especially for those who underwent preoperative radiotherapy. Pulmonary infection was the most frequent medical complication, and those who had a higher ASA grade tended to have more complication.

Key words: oral maxillofacial- head and neck cancer, perioperative mortality, rupture of carotid artery, radiotherapy, chemotherapy, pulmonary infection, ASA grade

CLC Number: 

  • R782

Tab 1

Clinical and demographic characteristics of the patients n = 55"

Variable n
Age[median number （min-max）,y] 63（24-88）
Sex Male 39
Female 16
Smoking history Yes 12
No 43
General morbidity Yes 28
No 27
Tumor recurrence Yes 20
No 35
Previous operation Yes 24
No 31
Previous radiotherapy Yes 20
No 35
Previous chemotherapy Yes 9
No 46
Receive operation （this time） Yes 51
No 4
ASA grade Ⅰ 1
Ⅱ 33
Ⅲ 16
IV 4
V 1
Operation time [median number （min-max）, min] 420（60-780）
Operative blood loss [median number （min-max）, mL] 600（50-1 400）
Airway management Tracheotomy 37
Throat colostomy 2
No 6
POM time classification Preoperative 4
Intraoperative 1
Postoperative 50
POM complication classification Surgical 12
Medical 31
Mixed 10
Personal 2

Table 2

Composition of systemic comorbidities"

Systemic comorbidity Number
Hypertension 15
Diabetes 6
Cerebral infarction 2
Epilepsy 1
COPD 3
Premature beat 2
Hypoproteinemia 1
Cerebral hemorrhage 1
MI 4
CHD 13
SS 1
Raynaud′s disease 1
CGN 1
Asthma 1

Table 3

Pathological diagnosis and tumor region"

Diagnosis and region n
Squamous cell carcinoma mucosa
Maxilla and skull base
 2
Mandible 10
Buccal 8
Tongue 7
Cervical 4
Parapharyngeal 5
Parotid 1
Osteosarcoma Maxilla and skull base 1
Chondrosarcoma Maxilla and skull base 1
Malignant hemangioendothelioma Buccal 1
Ameloblastoma Mandible 1
ACC Maxilla and skull base 1
MEC Cervical 3
Parotid 1
Lymphoma Maxilla and skull base 1
Epidermoid carcinoma Infraorbital 1
Inflammatory myofibroblastic tumor
with local malignancy		 Maxilla and skull base
 3
Mandible 3
Malignant hemangioendothelioma Buccal 1
Total 55

Table 4

Etiology composition of perioperative mortality"

POM Number
Preoperative POM-
Medical		 MI
 1
Heart failure 1
Electrolyte disturbance 1
Pulmonary infection 1
Intraoperative
POM- Surgical		 Hemorrhage
 1
Postoperative POM-
Surgical		 Rupture of carotid artery
 8
Asphyxia caused by hematoma 3
Postoperative POM-
Medical		 Pulmonary embolism
 5
MI 5
Heart failure 1
Electrolyte disturbance 1
Pulmonary infection 6
Cardiopulmonary arrest 2
Pancreatitis 1
MODS 7
MODS+DIC 1
Shock 1
Mix
Pulmonary infection+Hemorrhage 4
Aspiration+ Pulmonary infection+
MODS+ Hemorrhage		 2
Postoperative hemiplegia+
Pulmonary infection		 1
Pulmonary embolism+ Urinary
tract infection		 1
MODS+DIC+ Hemorrhage 1
Personal： fall from cycling 1
Personal： patient′s relatives
refuses rescue		 1
Total 55

Table 5

The time characteristic of perioperative mortality under different variables"

Variable Median time
（day）		 Range
（day）
Age （years） ≤ 65 11 3-65
>65 10 2-120
Sex Male 10 2-120
Female 16 3-42
Smoking history Yes 13 5-35
No 10 2-120
General morbidity Yes 8 2-65
No 11 2-120
Tumor recurrence Yes 14.5 3-30
No 10 2-120
Previous operation Yes 11 3-65
No 10 2-120
Previous radiotherapy Yes 10 2-65
No 11 2-120
Previous chemotherapy Yes 8 2-65
No 11 2-120
ASA grade Ⅰ 10 -
Ⅱ 11 3-120
Ⅲ 10 2-65
Ⅳ 5 2-8
Ⅴ 8 -
Operation time（min） ≤ 420 10 3-65
>420 10 2-120
Operative blood loss（ml） ≤ 600
>600 12 3-120
Airway management Tracheotomy 10 2-65
Throat colostomy 7.5 5-10
No 14 3-120
Mortality composition Surgical 10 3-15
Medical 14 2-120
Mix 12.5 3-30
Personal 12 2-22

Table 6

Analysis of the composition of perioperative mortality under different condition"

Condition POM composition P
Surgical Medical Mix Personal
ASA 1 1 0 0 0 0.039
2 9 15 8 0
3 2 12 2 1
4 0 3 0 1
5 0 1 0 0
Age ≤ 65 9 15 6 0 0.170
>65 3 16 4 2
Airway management Yes 10 22 6 1 0.594
No 2 9 4 1
General morbidity Yes 4 17 6 1 0.571
No 8 14 4 1
Previous radiotherapy Yes 5 10 5 0 0.509
No 7 21 5 2
Previous chemotherapy Yes 4 4 1 0 0.323
No 8 27 9 2
Tumor recurrence Yes 6 11 3 0 0.514
No 6 20 7 2
Blood loss（mL） ≤ 600 7 19 7 2 0.674
> 600 5 12 3 0
Operation time（min） ≤ 420 7 15 6 1 0.896
>420 5 16 4 1
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