Assessment of morbidity and mortality in emergency tracheotomy in head-and-neck cancer patients under palliative care.

Abstract

Introduction: Progression of advanced-stage head-and-neck cancer (HNC) can lead to respiratory distress requiring emergency tracheotomy. In the context of palliative care, this raises major prognostic and ethical issues. The present study sought to assess survival and morbidity after emergency tracheotomy in HNC patients under palliative care.

Material and methods: A 2-center retrospective study included all HNC patients in palliative care who underwent emergency tracheotomy between 2000 and 2023 in our institution. Demographic, clinical/pathologic and survival data were analyzed.

Results: Thirty-eight of the 1243 tracheotomies performed during the study period were for patients in palliative care. Mean age was 64.5±11.9years. Ninety-five percent of cancers were stage IV and 40% were metastatic. Forty-two percent of patients experienced postoperative complications. No deaths directly implicated surgery. Median overall post-tracheotomy survival was 2months (IQR: 1-4months), for a mean 4.3±6.6months. Discharge home was the only significant protective factor (HR: 0.27; P=0.006).

Conclusion: Emergency tracheotomy is rare in the context of palliative care, with fewer than 2 cases per year in our center. It prolongs survival by a few weeks, but at the cost of elevated morbidity. Indications should be anticipated and discussed in a tumor board including palliative care professionals.