PIG Meeting: 18th February 2021

86 year old man, consult for Partial Maxillectomy and free flap

Background

• Chronic lesion in left maxillary sinus with one episode of bleeding last year.
• CT showed aggressive infiltration in posterior maxilla and pterygoid plates.

Issues

• Multiple co-morbidities but no active concerns at present and has good QoL at home with wife and supportive family

Discussion

• Perioperative Risk scoring – SORT score and NSQIP both showed significant risk of mortality, but numbers were discordant 11 vs 3.3%. Why was this?
• Discussion around the nuances of each risk calculator; SORT score comparatively calculates less risk for cancer patients whereas NSQIP can appear to overestimate perioperative risk, not the case in this instance.
• The consensus was that the morbidity outcomes were very significant for this patient regardless of mortality outcomes.
• Patient and family very concerned with preserving QoL and understanding of the limitations of his age and co-morbidities.

Plan

• Discussion with surgical team regarding other, less invasive surgical options or radiotherapy.
• Surgical MDT is next week. Further discussion required before proceeding to surgery.