Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients

John Christian Lemoine; Vilija Vaitaitis; Trisha Jarreau; Joel St Germain; Leslie Son; Anna M Pou; Ashley Mays

doi:10.1055/s-0042-1745726

Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients

Int Arch Otorhinolaryngol. 2023 Apr 28;27(2):e329-e335. doi: 10.1055/s-0042-1745726. eCollection 2023 Apr.

Authors

John Christian Lemoine¹, Vilija Vaitaitis², Trisha Jarreau³, Joel St Germain³, Leslie Son⁴, Anna M Pou⁵, Ashley Mays²

Affiliations

¹ Department of Otolaryngology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States.
² Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States.
³ Department of Speech and Language Pathology, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States.
⁴ Department of Otolaryngology, Our Lady of the Lake Regional Medical Center, Louisiana, United States.
⁵ Department of Otolaryngology, Ochsner Health Center - Covington, Covington, Louisiana, United States.

Abstract

Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid = 4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection ( p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

Keywords: complete decongestive therapy; head and neck cancer; head and neck surgery; lymphedema; manual lymph drainage.

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