EP 496 Life-Saving Head and Neck Cancer Surgery Beyond the Tertiary Centre
Leticia Gatti Fonseca, Taisa Figueiredo, Barbara Gonçalves, Izabela Argentati, Gabriel Ferrarini, Marcos MoraesAbstract
Aim
We report the case of a 61-year-old woman with long-term tobacco exposure who presented with progressive dysphagia, significant weight loss, and acute airway compromise caused by an advanced squamous cell carcinoma of the larynx with hypopharyngeal extension (pT4aN2b). The patient was admitted with life-threatening airway obstruction, precluding safe transfer to a tertiary referral center.
Methods
Definitive surgical management was therefore undertaken in a peripheral public hospital within the Brazilian Unified Health System (SUS), a tax-funded universal healthcare system comparable in structure and principles to the UK National Health Service (NHS). The institution serves a highly vulnerable population and operates with limited resources, lacking microvascular reconstruction, a formal head and neck multidisciplinary team, and integration into a high-complexity oncologic referral network. In this context, referral waiting times for priority oncologic cases frequently exceed six months.
Results
Given the imminent risk of death while awaiting transfer, the patient underwent emergency total laryngopharyngectomy with thyroidectomy, bilateral neck dissection, and reconstruction using a pectoralis major myocutaneous flap. Despite the advanced stage of disease and institutional limitations, postoperative recovery was satisfactory. The patient regained oral alimentation, achieved acceptable functional outcomes, and remains disease-free 82 months after surgery.
Conclusions
This case highlights the feasibility and oncologic adequacy of definitive head and neck cancer surgery performed outside tertiary centers when delays in referral pose a direct threat to life. It underscores the importance of surgical decision-making, adaptability, and ethical responsibility in resource-limited public health systems, delivering insights for surgeons in universal healthcare systems facing common challenges.