Does neck dissection increase stroke after treatment in oral cavity cancer patients?

• Main Authors: Chia-Fan Chang, 張嘉帆
• Other Authors: Christy Pu
• Format: Others
• Language: en_US
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/07135400030348829538

碩士 === 國立陽明大學 === 醫務管理研究所 === 102 === Background: Oral cavity cancer is the most common head and neck cancer in Taiwan. Patients with head and neck cancer have higher risk of stroke after treatment than general population. The cause of stroke may be related to treatment modalities, including surgery, radiotherapy and chemotherapy. Radiotherapy on neck and chemotherapy can induced carotid artery stenosis or arterial thrombosis. The relationship between surgery and stroke is unclear. We assumed that neck dissection may involve fibrosis, exposure and manipulation of vascular structures of neck and induce subsequent stroke. This study was conducted to determine the incidence of stroke after surgery in oral cavity cancer patients and the risk of stroke after neck dissection. Methods: The Taiwan National Health Insurance Research Database (NHIRD) was used for this population-based study. Patients with newly diagnosed oral cavity cancer between Jan 1, 2005 and Dec 31, 2007 were involved. All patients received surgical treatment after diagnosis and divided into two groups, non-neck dissection and neck dissection. 1:2 match on gender, age, hypertension, previous stroke, coronary artery disease and arrhythmia was used to reduce baseline demographic bias. The end point was newly onset of stroke, withdrawal from insurance, or Dec 31, 2011. The confirmation of stroke events was admitted to the hospital. Results: Neck dissection does not increase the risk of stroke after treatment. Patients with age older than 44 had higher risk of stroke than those with younger or equal to 44 years. Patients with hypertension, diabetes mellitus, coronary artery disease or previous stroke had higher risk of stroke than those without one of these diseases. Compared with different adjuvant therapy, patients with postoperative radiotherapy and chemotherapy had the highest risk of stroke. Conclusions: Oral cavity cancer patient after neck dissection did not have higher risk of stroke. Patients with postoperative radiotherapy and chemotherapy had the highest risk of stroke, compared with different adjuvant therapy. The risk of stroke must be judged with benefits of oncologic outcome. For resectable oral cavity cancer, neck dissection would be preferred. Postoperative radiotherapy and chemotherapy was dependent on the pathologic result. Once the oncologic outcome was good, the analysis of postoperative stroke is worthy.