What is the risk of hemorrhage in cervical (neck) dissection?

From the Guidelines

The risk of hemorrhage in cervical (neck) dissection is estimated to be around 2%-4% due to the nature of the surgery being classified as major, according to the most recent and relevant evidence 1. To minimize this risk:

• Ensure meticulous surgical technique and hemostasis throughout the procedure.
• Use bipolar electrocautery for small vessels and careful ligation for larger vessels.
• Identify and preserve major blood vessels, including the internal jugular vein and carotid artery.
• Consider using hemostatic agents like Surgicel or Floseal in areas prone to oozing.
• Maintain close postoperative monitoring for signs of hematoma formation. Preoperatively, discontinue anticoagulants and antiplatelet medications when safe to do so. For patients on warfarin, aim for an INR <1.5 before surgery. If bridging is necessary, use low molecular weight heparin and stop it 24 hours before the procedure. Intraoperatively, maintain normotension and avoid excessive neck extension to reduce venous congestion. Use a head-up position of 15-30 degrees to improve venous drainage. Postoperatively, apply gentle pressure dressing and consider drain placement. Monitor for signs of bleeding, including neck swelling, dyspnea, or tachycardia. Resume anticoagulation only when hemostasis is assured, typically 24-48 hours after surgery. The rich vascular supply of the neck and the presence of major vessels make bleeding a significant concern. Careful technique and perioperative management are essential to minimize this risk and ensure optimal patient outcomes, as supported by the evidence that surgical procedures like head and neck cancer surgery have a high bleeding risk 1.

From the Research

Risk of Hemorrhage in Cervical Dissection

• The risk of hemorrhage in cervical dissection is a potential complication of the procedure, as noted in studies 2, 3, 4.
• Intraoperative bleeding can usually be well controlled, but early postoperative bleeding poses a greater danger to the patient 2.
• Various techniques, such as clip, ligature, or vessel sealing, can be employed to prevent early postoperative bleeding 2.
• The use of tranexamic acid and iron intravenously may also help reduce the risk of hemorrhage and postoperative anaemia, although their use was found to be limited in some studies 5.
• Studies have reported that the incidence of anaemia and blood transfusions varies depending on the type of surgery, with neck dissection only having a lower incidence of anaemia and blood transfusions compared to free flaps 5.

Prevention and Management of Hemorrhage

• Exact anatomical knowledge and precise dissection are crucial in preventing complications, including hemorrhage, during cervical dissection 2.
• Intraoperative neuromonitoring (IONM) can help prevent bilateral nerve damage, but primary reconstruction can improve vocal cord function in cases of accidental nerve damage 2.
• Lesions of the thoracic duct can be controlled by clip, ligation, or stitch, and smaller lesions of the trachea and esophagus can be secured with direct suture or muscle flap plasty 2.
• Preoperative, intraoperative, and postoperative methods can be employed to reduce the risk of complications, including hemorrhage, following radical neck dissection 4.