Chang Woo Lee

and 8 more

Background: There is an increasing importance to increasing the day-case rate for children undergoing adenotonsillectomy. The primary aim of this study was to evaluate the immediate post-operative complication (IPOC) rate of children undergoing adenotonsillectomy for the treatment of paediatric obstructive sleep apnoea (OSA), with a view to increasing the day-case rate. IPOC was defined as any adverse clinical events experienced if admitted, or as a re-presentation to the emergency department/ward if done as a day-case, within 24 hours of the surgery. The secondary aim was to evaluate the risk factors predictive of IPOC. Methods: A retrospective analysis of children undergoing adenotonsillectomy for OSA between 01/11/2019–31/03/2022. Results: 464 children were included. Children done as a day-case experienced 0% IPOC (n=260; 220 were planned day-case). Children done as an inpatient experienced 16.7% IPOC (n=34/204). Every child who experienced IPOC had one or more of the following four clinical features: age <3 years, <15 kg, >98th weight centile, significant medical comorbidities. 269 children had none of these four clinical features, and experienced 0.371% IPOC (n=1/269; primary post-tonsillectomy bleed). Children with pre-operative oximetry scores of McGill 3-4 experienced 0% IPOC if they had none of the four clinical features (n=20). The overall readmission rate was 2.80% (n=13/464). Conclusion: Our experience suggests children with none of the four clinical risk factors identified can have adenotonsillectomy performed as a day-case procedure, irrespective of the pre-operative oximetry results. Pre-operative oximetry does not appear to add any additional value in predicting adverse post-operative events.

Amarkumar Rajgor

and 6 more

Background: Our centre has favoured primary surgery over chemoradiotherapy(CRT) for specific advanced laryngeal cancer patients with large volume tumours, airway compromise, significant dysphagia and T4 disease. Some reports suggest surgery is associated with higher oncological control than organ-preservation strategies. This study reports the survival outcomes for a modern, high-volume head and neck centre favouring surgical management approaches. Methods: Patient data was collated retrospectively over a 7-year period from a tertiary head and neck specialty centre. Kaplan-Meier survival analysis and the Cox-proportional hazards model were employed for survival analyses. Results: The study population included 121 patients with T3(n=76) or T4(n=45) laryngeal cancer with a mean follow-up of 2.9 years. 104(86.0%) patients were treated with curative intent. Of which, 14(11.6%) received radiotherapy, 40(33.1%) received chemoradiotherapy (CRT), 19(15.7%) underwent surgery alone and 31(25.6%) underwent surgery with adjuvant therapy. In the cohort treated with curative intent, the 2-year and 5-year estimated disease-specific survival was 77.9% and 64.1% respectively. CRT had the highest 2-year DSS(92.5%), followed by surgery with adjuvant therapy(81.8%), RT alone(75%) and surgery alone(72.4%). Prognostic factors identified for disease-specific survival included age, tumour subsite and treatment modality. Conclusion: For a centre favouring primary surgery for certain advanced laryngeal cancers, the DSS appears no higher than published literature. The DSS following CRT is encouraging and we postulate that more of our patients may have benefitted from this treatment. To truly enhance survival, future research needs to move away from identifying treatment superiority and focus on precision medicine to define treatment pathways in this disease.