6th ICHNO Abstract Book

6th ICHNO 6 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 16 – 18 March 2017 Barcelona, Spain __________________________________________________________________________________________ (42.2%), 2 times in 28 patients (20.8%) and 3 times in 6 patients (4.4%). page 63

series is removed from the overall post-operative stroke or death rate calculation. Therefore, following 328 procedures, 5 patients (1.52%) died within the post- operative period and 15 patients (4.57%) suffered major stroke or death in the post-operative period.This is an improvement from outcomes described by the meta- analysis of Snyderman et al, who found carotid resections were complicated by major neurological deficit in 16.7% of patients. Rates of post-operative stroke did not differ between patients that underwent tumour peel and those that underwent resection and reconstruction (p = 0.76). Whilst rates of carotid blowout syndrome were greater than twice as high within the tumour peel group, the results were not significant (p = 0.11). The evidence pertaining to oncological outcomes weighs in favour of performing resection and reconstruction, as opposed to performing tumour peel. Conclusion When considering the available evidence, the best oncological outcomes are most likely achieved by centres performing carotid resection and reconstruction. It can also be seen that outcomes are further improved when surgery is performed as the primary treatment modality, in the absence of metastatic lesions. There is also evidence to suggest that performing resection and reconstruction may reduce the risk of carotid blowout syndrome compared with tumour peel. PO-132 Risk of re-operation for bleeding in head and neck surgery. E. Haapio 1 , I. Kinnunen 1 , J. Airaksinen 2 , H. Irjala 1 , T. Kiviniemi 2 1 Turku University Central Hospital, Otorhinolaryngology, Turku, Finland 2 Turku University Central Hospital, Heart center, Turku, Finland Purpose or Objective Intraoperative bleeding complicates the identification of crucial structures in head and neck area and is potentially fatal. We conducted a retrospective study to assess head and neck cancer (HNC) operations which carry high risk factors for re-operation due to postoperative bleeding. Material and Methods Study included a total of 456 patients (591 operations) who underwent surgery for HNC between 1999-2008 in tertiary care center of Turku University Hospital. Need of re-operation for bleeding was evaluated. Results Data on intraoperative bleeding was available in 265 operations. Median estimated intraoperative bleeding was 700mL [IQR 800] and operations with ≥ 700ml bleeding were defined as high bleeding risk operations. High bleeding risk operations included surgery with microvascular reconstruction or reconstruction using pedicled regional flap, salivary gland operation with neck dissection and major sinonasal surgery. Moreover, high bleeding risk operations were associated with increased risk for re-operation due to postoperative bleeding (p=0.001). Other risk factors for re-operation because of postoperative bleeding were history of heavy alcohol consumption (p=0.014), preoperative oncologic treatment (p=0.017), higher tumor stage (p=0.020), higher T- classification (p=0.034) and over 4000ml fluid administration within the operation day (24h) (p>0.001). Re-operation for bleeding was an independent risk factor for 30-day mortality after operation (p=0.014). Conclusion High bleeding risk operation, heavy alcohol consumption, preoperative oncologic treatment, higher tumor stage and

Patients who received EN before treatment were respectively: 2 in the S group (mean length (SD): 2 (1.4) days), 1 in the RT group (mean length: 43 days), 1 in the CT group (mean length 47 days), 7 in the RTCT group (mean length (SD): 14.7 (12) days), 5 in the IND group (mean length (SD): 25.8 (14) days). Pretreatment EN was received by no patient in the surgery +RT and surgery +RTCT groups. Regarding the post treatment period, the number of patients having received EN is: 20 in the S group (mean length (SD): 42.3 (59) days), 4 in the RT group (mean length (SD): 72 (14) days), 1 in the CT group (mean length 53 days), 22 in the RTCT group (mean length (SD): 102.7 (93) days), 15 in the IND group (mean length (SD): 103.4 (100) days), 8 in the surgery +RT group (mean length (SD): 32 (30) days) and 20 in the surgery +RTCT group (mean length (SD): 70.5 (110) days). Some patients always beneficiated from EN 18 months after treatment start. Conclusion Enteral nutrition seems necessary during the post treatment period in 66.7% of patients, whatever the type of treatment received. PO-131 Resecting the carotid artery for invasive head and neck cancer: Time to reconsider its feasibility A. Jones 1 , C. Daultry 2 , J.C. Wilton 1 1 University of Birmingham, Medical School, Birmingham, United Kingdom 2 Queen Elizabeth Hospital, ENT, Birmingham, United Kingdom Purpose or Objective Head and cancer invading the carotid artery poses a difficult question for the clinician as the optimum management strategy is unclear. What is known is that carotid artery involvement is a poor prognostic indicator with survival rates ranging from 0% to 35% at 1 to 2 years. The surgical options include peeling the tumour from the carotid artery adventitia, performing en bloc resection and ligation of the carotid artery, or en bloc resection followed by reconstruction of the carotid artery. Aims: Does survival time improve with surgery compared with chemoradiotherapy (CRT)? If so, does the survival benefit outweigh the risks of surgery? When surgery has been decided upon, what is the most effective method of resection and should reconstruction of the carotid artery be attempted? Material and Methods This review reflected upon the major historical papers and provides an in-depth analysis of research over the last 10 years pertaining to the management of malignant carotid invasion. Results Survival outcomes are presented in Table 1. Okamoto et al reported 100% mortality at 8 months of patients who did not undergo surgical intervention and no patients survived longer than 15 months who underwent CRT within the series by Roh et al. The evidence suggests that with careful selection of patients, surgical management can improve survival outcomes and may be the only solution to achieve long term survival. Following 401 surgical procedures involving the carotid artery, 14 patients suffered strokes (3.49%) and 22 patients (5.49%) suffered carotid blowouts. Zhengang et al do not provide peri-operative mortality data; as such their Poster: Minimal invasive and reconstructive surgery