Concurrent Extractions With Head and Neck Free Flap Surgery: A Pull to Get to PORT

Sunday, September 29, 2024

8:24 AM – 8:30 AM EDT

Location: MBCC, 208

Disclosure(s):

James D. Warren, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amy K. Krecker, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sarah J. Hayek, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Anne C. Kane, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The American College of Surgeons/Commission on Cancer recently (2022) approved a quality metric for surgically resected head and neck squamous cell carcinoma (HNSCC) patients to initiate post-operative radiation therapy (PORT) within 6 weeks. This has highlighted a high rate of delayed PORT. Delayed dental evaluation and extractions are strongly associated with delayed PORT. We aim to evaluate feasibility of concurrent dental extractions with major head and neck surgery and the impact on time to initiation of PORT.

Methods: A retrospective chart review was performed at a tertiary care academic center of adult HNSCC patients undergoing free flap reconstruction between 2020-2023. Demographics, intra-operative data, and post-operative outcomes were collected. Analysis was performed to determine impact of concurrent extractions on outcomes such as PORT initiation time, surgery time, and length of hospital stay.

Results: A total of 112 patients were identified. Excluding edentulous patients (N=76), 35 (46.1%) received concurrent dental extractions with surgery, and 41 (53.9%) did not. Extraction patients had significantly longer hospitalizations (9.41 vs 7.36 days; p=0.021), but no significant differences in complications (p=0.102) or readmissions (p=0.701). In non-edentulous patients without prior radiation (N=56), PORT initiation time was shorter in extraction patients, but not statistically significant (47.67 vs. 55.53 days; p=0.486). For all patients (N=112), surgery time was not significantly increased when extractions were performed (587.40 vs. 513.03 min; p=0.070).

Conclusions: This study shows the feasibility of concurrent dental extractions during oncologic resection and reconstruction. While statistically insignificant, the extraction group had a shorter PORT initiation time, impacting adherence to 6-week guidelines. Overall, impact to post operative course was minimal. These findings may be of particular importance in marginalized populations at risk for poor oral health.

Presenting Author(s)

James D. Warren, BS

Medical Student
University of Mississippi Medical Center
Jackson, MS, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Amy K. Krecker, MD

Resident
University of Mississippi Medical Center
Jackson, MS, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
PL

Peter H. Liddell, MD, JD

Resident
University of Mississippi School of Medicine
Jackson, MS, United States

Disclosure information not submitted.
TK

Timothy H. King, BS

Medical Student
University of Mississippi Medical Center
Flowood, Mississippi, United States

Disclosure information not submitted.
Sarah J. Hayek, BS

Medical Student
University of Mississippi Medical Center
Jackson, MS, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
GJ

Gina D. Jefferson, MD

Professor
University of Mississippi Medical Center
Jackson, MS, United States

Disclosure information not submitted.

Senior Author(s)

AK

Anne C. Kane, MD

Assistant Professor
University of Mississippi Medical Center
Jackson, MS, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.