Systemic complications after reconstruction for head and neck cancer: Factors contributing to upper airway obstruction, brain infarction, gastrointestinal hemorrhage, and pulmonary thromboembolism

Severe systemic complications developed in 48 of 2,426 patients undergoing reconstruction after resection of head and neck cancers at the East and Tokyo hospitals of the National Cancer Center, Japan, from June 1980 through December 2003. To identify causative factors, we reviewed 11 cases of upper airway obstruction, 8 cases of brain infarction, 5 cases of gastrointestinal hemorrhage, and 2 cases of pulmonary thromboembolism. We identified many possible causes of upper airway obstruction; tracheostomy should be performed when defects are large, when bilateral neck dissection has been done, and when patients are elderly. Most patients with brain infarction had a history of hypertension poorly controlled despite treatment with multiple agents. Appropriate blood pressures should be maintained during and after surgery in all patients. The stress of re-operation and treatment with nonsteroidal anti-inflammatory agents were believed to be the main causes of gastrointestinal hemorrhage. Although the incidence of pulmonary thromboembolism after head and neck reconstruction is low (0.08%), anticoagulants are indicated, especially for obese patients.