Comparison of Surgical Complications After Organ-Preservation Therapy in Patients With Stage III or IV Squamous Cell Head and Neck Cancer

Abstract

Objective: To determine the incidence of minor and major complications in patients with squamous cell carcinoma of the upper aerodigestive tract who require surgical salvage or planned neck dissection after an initial treatment regimen with radiotherapy or concurrent chemoradiotherapy for organ preservation.Design: The medical records of 100 patients treated in a phase 3 trial comparing radiotherapy alone with concurrent chemoradiotherapy for stage III and IV head and neck squamous cell carcinoma were reviewed. Fiftyfour patients underwent 59 surgical procedures. Twentynine planned neck dissections were performed for persistent neck disease or initial stage N2 or greater. For persistent or recurrent disease at the primary site, 30 salvage operations were performed.Setting: Academic tertiary care referral center.Results: Complications occurred in 15 (46%) of the 33 procedures in the radiation-only group and 12 (46%) of the 26 procedures in the chemoradiotherapy group. Major complications occurred in 4 (12%) of the procedures in the radiation-only group and 3 (12%) of the procedures in the chemoradiotherapy group. The incidence of minor complications was 33% and 35% in the radiation-only and chemoradiotherapy groups, respectively. The major complication rate for salvage operations did not differ between the radiation-only and chemoradiotherapy groups (16% and 27%, respectively; P=.79 by 2 test). The incidence of major complications in planned neck dissections was 7% of the radiation-only group and 0% of the chemoradiotherapy group. Conclusions:After radiation or concurrent chemoradiotherapy, surgery can be performed with an acceptable rate of major complications. Adding chemotherapy did not increase the incidence of surgical complications. These results differ from other reports in the literature.

Feasibility of Salvage Selective Neck Dissection after Primary Irradiation of Pharyngeal and Laryngeal Carcinoma

“…The prevalence of complications in the neck treated with radiotherapy alone was relatively higher if the radiation dose used was greater than 70 Gy [23]. Therefore, a lesser extent of neck surgery in the form of SND and SSND would minimize these complications that may arise from NDs [23, 24]. The other advantages of SND/SSND were preservation of internal jugular vein and sternocleidomastoid muscle, which could make significant differences in an irradiated neck.…”

Sialendoscopy for Definitive Management of a Submandibular Abscess following Radiotherapy for Oropharyngeal Squamous Cell Carcinoma

“…To our knowledge, this is the first such report and is unique in its avoidance of open surgery and tracheostomy in the setting of MRSA infection. The risks of transcervical and transoral incisions are increased in the setting of infection in a postradiation neck to rates approaching 46% [5, 6]. …”

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

“…However, some authors report that preoperative chemoradiotherapy as a cause of increased postoperative morbidity in laryngeal and hypopharyngeal surgery as compared to the primary surgery has been postulated [1,14,28].…”

“…However, the frequency of published pharyngocutaneous fistulas in salvage surgery ranges from 14% to 92% [28] depending the applied dose [31] the tumor stage and localisation [14] and time from initial therapy [28]. As a comparison, pharyngocutaneous fistulas after laryngectomy without previous therapy occurred in about 11% for hypopharyngeal [32] and in 4% for laryngeal carcinomas [33].…”