Complicaciones respiratorias en pacientes intervenidos por cáncer de cavidad oral, faringe y laringe en La Rioja
Introduction Cancer is one of the leading causes of morbidity and mortality worldwide. In recent years, survival rates for cancer have increased; however, this is not the case for head and neck cancers (HNC). HNC is the seventh most common cancer globally, and its incidence is estimated to increase by 30% annually until 2030. It encompasses a heterogeneous group of tumors, and this thesis focuses on tumors of the oral cavity, pharynx, and larynx, as sinonasal and nasopharyngeal tumors have different epidemiological, pathological, and therapeutic characteristics. Recently, a decrease in laryngeal cancers and an increase in oral cavity and oropharyngeal cancers have been observed, the latter related to human papillomavirus (HPV). The incidence of head and neck cancer (HNC) is directly related to tobacco and alcohol consumption, which explains why patients with HNC often present with comorbidities, notably chronic obstructive pulmonary disease (COPD). Several authors have shown that the presence of COPD increases the incidence of respiratory complications. The relationship between HNC, smoking, and COPD should be studied in detail to identify actions that reduce their prevalence and the complications arising from their treatment. Objectives - To describe the respiratory complications that occur after surgical intervention in these patients. - To analyze the factors associated with the appearance of respiratory complications in the postoperative period of patients undergoing surgery for head and neck cancer. - To characterize the tumors of the oral cavity, pharynx, and larynx diagnosed in patients from La Rioja. - To analyze the clinical and demographic characteristics of the subgroup of patients who developed respiratory complications. - To identify the occurrence of second primary tumors and/or pulmonary metastases in these patients. Methodology A descriptive, observational, and retrospective study was conducted, including patients treated for oral cavity, pharyngeal, and laryngeal cancer in La Rioja from January 2018 to December 2021. Variables recorded included sociodemographic data, medical history, preoperative pulmonary assessment and tests, tumor characteristics, surgical treatments performed, recorded respiratory complications, and secondary lung tumors during a three-year follow-up. Results A total of 160 patients were included. 74.4% were men, with a mean age of 72 years. 69.4% had a history of smoking, and 41.2% consumed alcohol. Comorbidities were documented in 82.5%, with hypertension being the most prevalent, and COPD ranked fifth at 8.1%. Only 16% of patients underwent spirometry, and less than 2% were evaluated by a pulmonologist before surgery. Laryngeal tumors were the most frequent (56.3%), predominantly glottic (40%). Oral cavity tumors accounted for 40.7%, with 55% being women, elderly, and without tobacco or alcohol habits. Most had localized disease (86.3%), and the majority of surgical techniques were partial and transoral. Ten patients (6.2%) experienced respiratory complications. Among these, 80% were smokers, and 30% had COPD, but none were evaluated by a pulmonologist prior to surgery. Diabetes mellitus and non-epidermoid cancer types were significantly associated with complications (p < 0.05).During the two-year follow-up, 14 new lung tumors were detected (8.8%). Conclusions Approximately 6.2% of patients treated for HNC experienced respiratory complications. Although this rate is lower than reported in other studies, it is noteworthy, especially considering that 30% of these patients had a prior diagnosis of COPD higher than the 8% in the series. Furthermore, none of the patients who experienced respiratory complications were evaluated beforehand to optimize the management of their pulmonary disease. These findings highlight the importance of identifying and treating COPD in patients with HNC and underscore the need for further research in this area.
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