HCG Manavata Cancer Centre (HCGMCC), a leading cancer specialty hospital in Nashik, has pioneered a standardized surgical protocol that significantly reduces the incidence of postoperative hematoma in head-and-neck cancer surgeries. The initiative, spearheaded by the hospital’s Plastic and Reconstructive Services team, represents a major leap forward in surgical precision, enhancing patient safety and postoperative recovery outcomes.

Introduced in April 2019, the protocol focuses on meticulous hemostasis, leveraging bright illumination and loupe magnification to identify critical bleeding sites. A retrospective study conducted between April 2019 and December 2022 demonstrated a substantial decline in postoperative hematoma cases—from 4.38% to 1.13%—with only 14 cases reported out of 1,234 patients undergoing surgery.

Head-and-neck cancer surgeries, particularly those involving free flap reconstruction, are complex and prone to complications, including hematoma, which can lead to severe consequences such as infection, airway obstruction, flap failure, and, in extreme cases, mortality.

“We conducted a study retrospectively between August 2017 and March 2019 and found that 4.38 per cent of patients (24 out of 548) developed postoperative hematoma, necessitating emergency re-exploration. Recognizing the need for a more effective strategy, we devised a comprehensive intraoperative checklist to enhance hemostasis and early hematoma detection and introduced the protocol which has proven to be a game-changer in head-and-neck cancer surgeries. By implementing the checklist, we have significantly minimized postoperative hematoma risks, improving surgical outcomes and patient safety. This approach can be easily adopted by head-and-neck surgeons worldwide to enhance care standards,” said Dr. Mohsina Hussain, Consultant – Head and Neck Surgical Oncology, HCGMCC.

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The standardized surgical protocol involves three primary components: Primary Site Evaluation, Neck Dissection Assessment, and Pressure Application & Valsalva Maneuver. With its initial success, HCGMCC aims to further its research through multi-institutional collaborations to validate and standardize the protocol on a global scale.

“With the protocol’s introduction all free flaps were salvaged, with no cases of flap failure or mortality due to hematoma. Additionally, the need for emergency re-exploration and prolonged ICU stays significantly declined, enhancing patient outcomes and reducing healthcare costs. At HCG Manavata, our focus has always been on innovation that directly improves patient care. This protocol exemplifies how systematic surgical advancements can drastically reduce complications, enhance recovery and set new benchmarks in oncology care. Our ultimate goal is to integrate these best practices across institutions worldwide,” stated Prof. Dr. Raj Nagarkar, MD & Chief of Surgical Oncology & Robotic Services, HCGMCC.

The success of HCGMCC’s groundbreaking protocol underscores the hospital’s commitment to pioneering advancements in cancer care. By setting new standards in surgical precision and patient safety, the institution continues to lead the way in innovation-driven healthcare. As HCGMCC expands its research through multi-institutional collaborations, this protocol has the potential to revolutionize head-and-neck cancer surgeries worldwide, reducing complications, improving recovery, and ultimately enhancing the quality of life for patients.

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