Andry Guy, Hamoir Marc, Leemans C René
Surgery Department, Centre des Tumeurs ULB, Institut Jules Bordet, Brussels, Belgium.
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center/Cancer Center Amsterdam, 1007 MB, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 2018 Aug;275(8):2145-2149. doi: 10.1007/s00405-018-5046-9. Epub 2018 Jun 29.
Quality assurance is much more difficult to achieve in surgical oncology than in medical oncology and radiotherapy where doses are standardized and toxicities are well-classified. To better define what is required in surgery, we analyzed recent articles addressing the point in head and neck surgery.
The surgical report should match with the pathological description of the resected specimen with accurate delineation of the margins, number and level(s) of lymph nodes (capsular rupture if any). Complications (minor and major) should be standardized and meticulously recorded; as well as comorbidities and patient status. The acuity of the procedure should be defined by metrics collected in check-lists. Age > 60 years, male gender, tumor site and T stage, neck dissection(s), flap reconstruction, alcohol and tobacco consumption, are acknowledged risk factors for more complications and longer hospital stay (or readmission).
Randomized controlled trials should be designed adopting the consolidated standards of reporting trials (CONSORT). Training young head and neck surgeons should encompass formation in designing, conducting and interpreting clinical trials.
与剂量标准化且毒性分类明确的内科肿瘤学和放射治疗相比，手术肿瘤学中的质量保证要困难得多。为了更好地界定手术所需的条件，我们分析了近期关于头颈外科这一问题的文章。
手术报告应与切除标本的病理描述相符，准确描述切缘、淋巴结数量及水平（如有包膜破裂）。并发症（轻微和严重）应标准化并详细记录；合并症和患者状况也应如此。手术的难度应由检查表中收集的指标来界定。年龄>60岁、男性、肿瘤部位和T分期、颈部清扫术、皮瓣重建、饮酒和吸烟，是公认的导致更多并发症和更长住院时间（或再次入院）的风险因素。
应采用试验报告统一标准（CONSORT）设计随机对照试验。培训年轻的头颈外科医生应包括设计、开展和解释临床试验方面的培训。
