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ANN ARBOR, Mich. – A technique that illuminates blood flow during surgery has predicted which patients with head and neck cancer are likely to have healing problems. This could allow surgeons to make adjustments during surgery or recovery to improve outcomes.
A team of surgeons at the Rogel Cancer Center at the University of Michigan found the approach so successful in a clinical trial that they stopped the study at an early stage.
Most people with laryngeal cancer will have radiation therapy and chemotherapy. But about a third of the time, the cancer will reappear or prove resistant, leaving surgery in the background.
At this point, radiation damage to the tissue complicates the operation. When the surgeon closes the wound, the damaged tissue may interfere. For about 40% of patients, this will lead to a pharyngo-cutaneous fistula, a hole in the neck where saliva can flow. It can cause bleeding or infections, force patients to stay longer in the hospital and, in 10% of cases, send them back to the operating room to fix it.
"Damage from radiation is something you can not always see, there have been very few examples in the literature that could explain or predict who will have a complication," says Matthew E. Spector, MD, badistant professor of otolaryngology (head and neck) surgery at Michigan Medicine. Spector is the lead author of a paper published online in February, before the final publication in May Annals of Surgical Oncology.
The researchers recruited 41 patients undergoing laryngectomy after radiotherapy. After removing the tumor but before closing the throat, the anesthesiologists administered to patients an intravenous injection of a type of medical dye, the indocyanine green. The dye circulates in about 40 seconds. Surgeons then use laser angiography, which illuminates the dye and allows them to observe the blood flow.
The results were clear: patients with lower blood flow had a significantly higher risk of developing a fistula, while patients with high blood flow had a very low risk of wound complications.
Knowing this, Spector suggests some possible interventions. You could cut a larger margin of tissue to get a cleaner, healthier edge. Another possibility is to keep high-risk patients longer in the hospital, while sending low-risk patients home faster.
The approach of laser angiography would be simple to implement in many contexts. It is already used by other surgeons, including for bad reconstruction, and many hospitals already own one. The technique has little impact on patients because it can be administered very quickly while they are still under anesthesia. The reactions to indocyanine are minimal.
Researchers are currently developing a randomized clinical trial to determine whether reducing the number of tissues leads to fewer fistulas in the high-risk group.
"We need to find an intervention that can reduce this risk," said Spector.
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Resources:
University of Michigan Rogel Cancer Center, http: // www.
Michigan Health Lab, http: // www.
Michigan Cancer Tracking Line, 800 865-1125
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