Nashik based  HCG Manavata Cancer Centre has introduced a new surgical protocol that significantly decreases the incidence of postoperative haematoma in surgeries related to head-and-neck cancer. 

The HCG Manavata Cancer Centre (HCGMCC) in Nashik has established a surgical protocol designed to minimise postoperative haematoma in surgeries related to head-and-neck cancer. In April 2019, the hospital’s Plastic and Reconstructive Services team introduced a method aimed at enhancing haemostasis. This approach uses techniques such as bright illumination and loupe magnification to examine potential bleeding sites. A study done from April 2019 to December 2022 showed that the number of postoperative haematomas went down, dropping from 4.38% (24 out of 548 patients) in an earlier period to 1.13% (14 out of 1,234 patients) after the new protocol was put in place. 

Surgeries for head-and-neck cancer, particularly those that include free flap reconstruction, are complex procedures that involve inherent risks. Haematoma, characterised by the accumulation of blood outside of blood vessels, represents a significant complication that may result in infections, airway complications, flap failure, or even mortality if not properly managed. The protocol consists of a three-step checklist: first, evaluating the surgical site for potential bleeding risks; second, assessing the neck dissection phase to address possible complications; and third, employing pressure and the Valsalva manoeuvre to identify concealed bleeding areas. 

Dr. Mohsina Hussain, a consultant in head-and-neck surgical oncology at HCGMCC, reported that a review conducted from August 2017 to March 2019 indicated that 4.38% of patients required emergency re-exploration as a result of haematoma. A new checklist has been developed to mitigate these risks. The study indicated that there were no instances of flap failures or fatalities associated with haematoma. Additionally, it noted a reduction in emergency re-examinations and a decrease in the duration of ICU stays. 

Prof. Dr. Raj Nagarkar, who leads surgical oncology and robotics services at HCGMCC, stated that the approach minimises complications and costs while ensuring the preservation of all free flaps. The hospital intends to work with various institutions to conduct additional tests and explore the potential for global standardised protocols. The method focusses on a structured approach aimed at improving surgical outcomes; however, its long-term effects and wider implementation are still being evaluated. 

The protocol aims to enhance surgical practices for patients with head-and-neck cancer by implementing structured assessments designed to reduce postoperative complications. The initial results indicate a reduction in complications; however, the hospital acknowledges the necessity for further research to validate its effectiveness in various contexts. The approach indicates a transition to evidence-based methods in surgical oncology, which could have significant implications for the consistency of patient care and the utilisation of resources pending further validation.