Postoperative considerations in patients following oral cancer resection and surgical reconstruction: a review

: Wide institutional variation exists in the immediate care of patients following major oral cavity, pharyngeal or laryngeal resection for oral cancer. This is a vulnerable patient cohort, where age, comorbidity and frailty combine with potentially prolonged and complex resection and reconstructive surgical procedures. The environment in which these patients receive their immediate postoperative care can vary depending on the institution, but the key is that the patients are cared for in a facility which is familiar with the surgical procedure and the patient cohort. Patients who have undergone free flap reconstruction are at risk of flap failure due to venous or arterial compromise or wound dehiscence. Early identification of flap compromise is vital, regardless of the methods used to monitor the flap. Airway compromise is also a risk that needs to be carefully monitored. Clear communication between the surgical and ward teams will decrease the risk of a critical airway following tracheal extubation. Postoperative nutrition must be addressed early. These patients are at risk of becoming malnourished, if not already so. Their caloric requirements should be calculated to include the metabolic demands of wound healing and the stress response to surgery. Involving a dietician allows for a tailored feeding regime to be established by whichever route is available e.g., oral, via a nasogastric tube or via a percutaneous gastrostomy tube. Other considerations for the postoperative care of these patients include the importance of clear documentation and handover from surgical to ward based teams. On admission to the ward, a systematic review should be carried out and issues such as hypotension or anaemia should be dealt with. Venous thromboembolism prophylaxis, management of substance withdrawal, identification and management of delirium and pain management are all important areas of post operative care. Due consideration should also be paid to the psychological impact of these major operations. This review article provides a comprehensive and detailed overview of evidence-based postoperative considerations for patients following major surgery for oral cancer.