What to Expect with Head & Neck Cancer Surgery

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Swedish Head & Neck Surgery / First Hill

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In the video below, Physician’s Assistant Allison Seamon discusses what you can expect when facing head and neck cancer surgery, particularly free flap surgery. Free flap surgery is a procedure to fill the wound after cancer has been removed. Free flap surgery involves taking tissue such as muscle, skin and bone if necessary, from somewhere else on your body and using it to patch the wound and reconnecting tiny vessels under a microscope to keep blood flowing to the newly repaired area.

Patients will likely require a week’s stay in the hospital. Patients that have this surgery will have a number of special needs afterwards, both in the hospital and after going home.

Preparing for Surgery

When getting ready for this type of surgery, the most important thing you can do is eat a healthy diet and maintain your weight. This may be difficult if you have pain in your throat or trouble swallowing.

Many head and neck cancer patients either smoke heavily or used to in the past. If you are still smoking, you should try to stop. Even a week or two without tobacco can improve your lung function, which makes for a quicker and easier recovery.

If you are regularly drinking alcohol, please tell us. It is very important that the surgical team knows if you’re drinking or using drugs and how much. This may affect how we care for you in the hospital. Please try to stop drinking or at least cut back before surgery in an effort to boost your health.

Light exercise before surgery is allowed and encouraged if you can tolerate it.

The Day of Surgery

On the day of surgery, you will need to come to the main hospital about 2 hours before your surgery start time, usually around 5:30 am.

Family members are encouraged not to stay at the hospital the day of surgery. The procedure will be very long, lasting sometimes 8 to 12 hours. Family members will be notified as soon as surgery is over with an update.

Lastly, when the operation is finished, it is not uncommon for patients to be kept asleep and on a breathing machine for the first night.

Immediately After Surgery

After free flap surgery, patients will stay in the intensive care unit for about 3 days so that staff can monitor the free flap very closely. After your stay in the ICU you will be moved to a surgery unit.

Most patients undergoing head and neck cancer surgery cannot eat by mouth right after the operation. If the doctor feels that it will be unsafe to eat by mouth, a narrow tube will be slid down your nose into your stomach during surgery. This tube is referred to as a nasogastric tube. It allows us to ensure that you are getting the nutrition that you need to heal.

Oral hygiene is important after these surgeries, especially if we are operating in your mouth. We will explain to you how to keep your mouth clean while you are in the hospital and when you go home.

There is usually some pain after surgery. Everyone has different pain tolerances. There are a variety of pain medications available and we will find the right combination to keep your pain controlled. Patients with good pain control may heal faster so it is important to take your pain medication if you need it.

You may have a drain, possibly more than one, near your surgical incisions. This will stay in for a couple of days. A temporary drain helps keep swelling down. Sometimes, although not often, patients go home with a drain still in place for a few days.

Once you are awake and clear headed, the therapists and nursing staff will help get you out of bed. Activity after surgery is very important. It helps improve your circulation and lung function, your bowel function and increases your stamina. You will walk in the halls with assistance daily.

After Discharge

Most patients will require some assistance after discharge. Home health care is available and often necessary. Depending on your needs, a short stay at a skilled nursing facility might also be an option, but this is typically not necessary.

If you have a spouse, family member, or friend that can help you, we will instruct them about your needs. If you live alone, you may need some home health care until you are able to manage on your own. There are plenty of support services available for patients during this process. The head and neck surgery team can help with these support options and resources.

Unless told otherwise, it is okay to shower and get your incisions wet. Just pat them dry gently afterwards. If your incisions need any extra care such as dressings, the surgical team will let you know and teach you exactly what to do. Otherwise, just keep your wounds clean and protected from the sun.

You will have some side effects from the surgery and the general anesthestics. The main effect is usually fatigue, which may last up to a week or two after the procedure. This is normal and you should take plenty of time off of work to allow yourself time to rest and recuperate. Expect swelling to your neck and face after your operation. It’s also common to have some numbness to the skin of your neck and face. The feeling should gradually come back with time.

If you need to go home on tube feedings, which is very common for our patients, your case managers in the hospital will make arrangements with an agency that provides tube feeding formula and supplies. Patients and their family members will be taught how to set up and give the tube feeding formula at home.

You may need some physical and/or occupational therapy to build back your strength. If this is necessary, we will arrange for a therapist who to come to your home to work with you.

Depending upon your cancer staging, some patients will need additional treatment after surgery such as chemotherapy or radiation. This will be discussed during the first or second post-operative visit.

Your first post-operative visit in the office will be anywhere from a couple days to a week after discharge. You should plan on seeing us frequently for the first month or two. After that, we will begin to space out your visits.

It is likely that you will need some speech and swallow therapy. If this is necessary, we will refer you to a speech pathologist. Speech therapy is especially important for those patients who will need radiation therapy to the throat after surgery.

After surgery, you are usually safe to drive once you are no longer taking pain medication. However, you should check with your doctor first.

When you have regained your energy, light exercise such as walking is welcomed and encouraged. But don’t overdo it! Ask your surgeon before trying more vigorous forms of exercise.

It is important to give up habits such as smoking or drinking. This can have a great effect on both your recovery as well as your risk of cancer recurrence.