AHNS
Osama A. Hamdi, MD
University of Virginia, Department of Otolaryngology - Head and Neck Surgery
The overall survival (OS) and recurrence free survival (RFS) of our two groups were determined using the Kaplan-Meier method and compared statistically using log-rank tests. Chi-square test and student t-test were used for analysis of the variables of each group.
Results: A total of 346 patients met the criteria for inclusion in the study. Group 1 consisted of 171 patients compared with 175 in group 2. The majority of patients had squamous cell carcinoma (84.4%), and the most common tumor site was the oral cavity (67.9%). Group 2 had a statistically significant higher rate of stage III/IV tumors (71.7% vs 60.5% in group 1, p=0.028). Mean length of stay was significantly shorter in group 2 (8.3days vs. 9.9 in group 1, p=0.001). Mean units of blood transfused per patient was significantly less in group 2 (0.26 vs 2.87 in group 1, p<0.001). Patients in group 2 also experienced significantly less postoperative wound breakdown or infections (14.3% vs. 26.3% in group 1, p=0.006). There was a difference between the types of flaps used in both groups, with group 1 having significantly more radial forearm free flaps whereas group 2 had an increased number of ALT flaps (p=0.006). Group 1 was associated with worse OS (p=0.01; hazard ratio [HR]=1.7) and RFS (p < 0.001; HR=2.5). Comparing only patients with SCC between the two groups also found poorer OS and RFS in group 1 (p=0.002; HR=2.0) and RFS (p < 0.001; HR=2.4). Free flap failure rates were the same in both groups (3.5% group 1 vs. 1.7% group 2; p=0.29).
Conclusion: After implementing a lower transfusion threshold of hematocrit <21 for HNC patients, we demonstrated an improvement in OS, RFS, and wound infection rates without any impact on free flap survival.