HCGMCC Pioneers Breakthrough Protocol To Reduce Postoperative Hematoma In Head-and-Neck Cancer Surgeries

Nashik’s leading cancer speciality hospital - HCG Manavata Cancer Centre (HCGMCC) has successfully developed a standardized surgical protocol that significantly reduces postoperative hematoma in head-and-neck cancer surgeries. The initiative, led by the hospital’s Plastic and Reconstructive Services team, marks a major advancement in surgical precision, improving patient safety and recovery outcomes. Implemented in April 2019, the standardized approach ensures meticulous hemostasis using bright illumination and loupe magnification to examine key bleeding sites. Following the protocol’s introduction, a study spanning April 2019 to December 2022 demonstrated a dramatic reduction in postoperative hematoma incidence from 4.38 per cent to 1.13 per cent i.e. 14 out of 1,234 patients.

Head-and-neck cancer surgeries, particularly those involving free flap reconstruction, are intricate procedures with a high risk of complications. Hematoma is a condition where blood pools outside of vessels post-surgery can lead to severe outcomes, including infection, airway obstruction, flap failure and even mortality.

“We conducted a study retrospectively between August 2017 and March 2019 and found that 4.38 per cent of patients (24 out of 548) developed postoperative hematoma, necessitating emergency re-exploration. Recognizing the need for a more effective strategy, we devised a comprehensive intraoperative checklist to enhance hemostasis and early hematoma detection and introduced the protocol which has proven to be a game-changer in head-and-neck cancer surgeries. By implementing the checklist, we have significantly minimized postoperative hematoma risks, improving surgical outcomes and patient safety. This approach can be easily adopted by head-and-neck surgeons worldwide to enhance care standards,” says Dr Mohsina Hussain, Consultant - Head and Neck Surgical Oncology, HCGMCC.

Implemented in April 2019, the standardized surgical protocol includes a checklist involving three primary studies including Primary Site Evaluation, Neck Dissection Assessment and Pressure Application & Valsalva Maneuver. While the initial study has shown remarkable success, HCGMCC aims to expand research through multi-institutional collaborations to further validate and standardize this protocol globally.

“With the protocol’s introduction all free flaps were salvaged, with no cases of flap failure or mortality due to hematoma. Additionally, the need for emergency re-exploration and prolonged ICU stays significantly declined, enhancing patient outcomes and reducing healthcare costs. At HCG Manavata, our focus has always been on innovation that directly improves patient care. This protocol exemplifies how systematic surgical advancements can drastically reduce complications, enhance recovery and set new benchmarks in oncology care. Our ultimate goal is to integrate these best practices across institutions worldwide,” concludes Prof Dr Raj Nagarkar, MD & Chief of Surgical Oncology & Robotic Services, HCGMCC.