Lung ultrasonography to assess pulmonary complications after head and neck cancer surgery - 11/02/26

Doi : 10.1016/j.jormas.2026.102741

Ling Gao ^{^{1
These authors contributed equally to this work.}}, Likuan Wang ^{^{1
These authors contributed equally to this work.}}, Xudong Yang, Dan Zhou ^⁎

Department of Anesthesiology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China

^⁎ Corresponding author at: Department of Anesthesiology, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices; Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China. Department of Anesthesiology Peking University School and Hospital of Stomatology National Center for Stomatology National Clinical Research Center for Oral Diseases National Engineering Research Center of Oral Biomaterials and Digital Medical Devices Beijing Key Laboratory of Digital Stomatology Beijing 100081 China

Abstract

Objectives

Postoperative pulmonary complications (PPCs) are common after major head and neck cancer surgery. This trial evaluated whether adding daily lung ultrasonography (LUS) to the current diagnostic strategy (clinical evaluation with on-demand chest X-ray [CXR]) improves PPC detection.

Methods

In this randomized controlled trial, 196 adults at intermediate/high risk for PPCs undergoing head and neck cancer surgery with free-flap reconstruction were assigned to the current strategy alone or a routine strategy (daily LUS plus current strategy). The primary outcome was the detection rate of clinically relevant PPCs.

Results

The routine strategy identified significantly more clinically relevant PPCs than the current strategy (92.3% vs. 66.7%, p = 0.035) with higher diagnostic accuracy (AUC: 91.9% vs. 80.4%, p = 0.035). Detection occurred earlier with the routine strategy (median postoperative day 2 vs. 3, p = 0.042). No significant differences were observed in hospital stay or mortality.

Conclusions

Incorporating daily LUS into postoperative care enhances the detection of PPCs in patients on general wards after head and neck cancer surgery, without significantly altering short-term clinical outcomes.

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Keywords : Lung ultrasonography, Chest X-ray, Diagnostic performance, Postoperative pulmonary complications, Head and neck cancer surgery, Free-flap reconstruction