Hemorrhage after surgical treatment of oropharyngeal carcinoma –⁠ comparison of surgical approaches

Overview

Introduction: The frequency and risk factors of bleeding from the pharynx after oncosurgical procedures are not often mentioned in the literature. Bleeding near the airways, however, poses a significant risk for patients in whom pharyngeal surgery is indicated. In our group, we focused on the potential risk factors of bleeding in oncosurgical procedures in the pharynx. At the same time, we were interested in whether the frequency of bleeding differs nowadays from procedures performed more than 15 years ago. Material and methodology: Retrospective analysis and statistical evaluation of risk factors for the occurrence of postoperative bleeding was conducted in a group of 99 patients from the ENT-HNS clinic of the Pardubice Hospital operated for oropharyngeal carcinoma, divided according to the dates of the operation into group A (2002–2009) and group B (2017–2019). Results: Monitoring the differences between the operated patients in groups A and B and the evaluation of risk factors for the occurrence of operative bleeding in all patients shows a statistically significant lower bleeding in group A. The only factor that reduces the risk of bleeding was ligation of the internal jugular vein in this study. Conclusion: Within the assessment of postoperative bleeding risk factors, statistical significance was detected in our cohort of patients who underwent oropharyngeal tumor resection regarding ligation of the internal jugular vein (IJV –⁠ vena jugularis interna). However, it is essential to emphasize that this association is not supported within the broader context of current scientific knowledge, and definitive conclusions necessitate prospective and multicentric verification with a comprehensive evaluation of risk factors. Ligation of the external carotid artery (ECA) on the ipsilateral side, tumor size, extent of resection, wound site reconstruction (flaps/grafts), and surgical technique did not influence the incidence of bleeding in our cohort. A statistically lower incidence of bleeding was demonstrated in Group A (2002–2009). In Group A, the following factors were significantly more frequent: resection of the tongue base and soft palate, utilization of monopolar coagulation and suture ligation, and IJV ligation. In Group B, reconstruction of the tumor resection site was significantly more frequent.

Keywords:

Hemorrhage – Oropharynx – carcinoma – internal jugular vein