Evaluating the role of topical tranexamic acid in cancers of the head-and-neck: A single-center randomized controlled trial

Background: Closed suction drains can reduce the complications associated with neck dissection (ND) by facilitating the removal of bodily fluids from the operated site. A lower drain output helps in faster wound healing, thereby leading to early drain removal and better recovery. Topical application of tranexamic acid (TXA) to the raw area created by surgery has been shown to be beneficial in reducing the bleeding in cardiac, orthopedic, and endoscopic nasal surgeries. Objectives: This study aimed at assessing whether the topical application of TXA after ND reduced the drain output, time to drain removal, and postoperative complications in patients undergoing surgery for head and neck cancers. Materials and Methods: The present study was performed in a tertiary care teaching hospital in north India between August 2014 and December 2017. One hundred patients with head and neck cancer who underwent ND were randomized into two groups. Group 1 received 20 ml of 25 mg/ml topical TXA per neck after hemostasis, and Group 2 underwent routine neck closure. Primary end points included the daily drain output until postoperative day 5 and the day of drain removal. Age, lymph node yield, operative time, type of reconstruction, and postoperative complications till 30 days postoperatively were also recorded. Results: The demographic and clinicopathological profiles were comparable between the two groups. Output from the neck drains was significantly lower in the TXA group compared to the standard closure group (208.29 ± 84.18 ml vs. 344.56 ± 110.93 ml; respectively, P < 0.0001). In addition, drain removal in the tranexamic acid group was done earlier than in the standard closure group (6.11 ± 1.20 days vs. 7.56 ± 1.42 days, respectively,P < 0.0001). Postoperative complications and requirement of secondary procedures were comparable between the two groups. Conclusions: Topical TXA effectively reduces the postoperative drain output after ND in patients with head and neck cancer. It facilitates the early removal of the drain and helps in better recovery without any significant difference in the rate of postoperative complications.