Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma |
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| Affiliation: | 1. Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France;2. Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy;3. Biostatistics Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France;4. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;5. University of Lorraine, CNRS, CRAN, F-54000, Nancy, France;1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China;3. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;4. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China;5. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing, China;6. Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an, China;7. Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;8. Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;9. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China;10. Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing, China;11. Department of General Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, China;1. Department of Surgery, McMaster University, Canada;2. School of Nursing, McMaster University, Canada;3. Department of Health Research Methods, Evidence, And Impact, McMaster University, Canada;4. Division of Thoracic Surgery, Department of Surgery, McMaster University, Canada;1. Professional Lead Dietitian, Department of Dietetics, Department of Nutrition and Dietetics, University Hospitals Plymouth NHS Trust, Plymouth, England, PL6 8DH, UK;2. Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, Plymouth, England, PL6 8DH, UK;1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;2. Institute of Innovative Cancer Research, Asan Medical Center, Seoul, 05505, Republic of Korea;3. Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea;4. Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea |
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| Abstract: | IntroductionThe risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting.Materials and methodsThe records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications.ResultsWith a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications.ConclusionWhen discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure. |
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| Keywords: | Head and neck surgery Radiotherapy Salvage surgery Recurrence Head and neck cancer |
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