Postoperative Complications After En Bloc Salvage Surgery for Head and Neck Cancer | Head and Neck Cancer | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Magrin  JCarvalho  ALKowalski  LP Sites of treatment failure in oral squamous cell carcinoma.  In: Varma  AK, ed.  Oral Oncology.Vol 6. New York, NY: Macmillan India Ltd; 1999:277-280. Google Scholar
Kraus  DHZelefski  MJBrock  HAHuo  JHarrison  LBShah  J Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx.  Otolaryngol Head Neck Surg.1997;116:637-641.PubMedGoogle Scholar
Franceschi  DGupta  RSpiro  RHShah  JP Improved survival in the treatment of squamous carcinoma of the oral tongue.  Am J Surg.1993;166:360-365.PubMedGoogle Scholar
Kowalski  LPBagietto  RLara  JRSantos  RLSilva  JF  JrMagrin  J Prognostic significance of the distribution of neck node metastasis from oral carcinoma.  Head Neck.2000;22:207-214.PubMedGoogle Scholar
Goodwin  WJ  Jr Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means?  Laryngoscope.2000;110:1-18.PubMedGoogle Scholar
Cooney  TRPoulsen  MG Is routine follow-up useful after combined-modality therapy for advanced head and neck cancer?  Arch Otolaryngol Head Neck Surg.1999;125:379-382.PubMedGoogle Scholar
Boysen  MLovdal  OTausjo  JWinther  F The value of follow-up in patients treated for squamous cell carcinoma of the head and neck.  Eur J Cancer.1992;28:426-430.PubMedGoogle Scholar
Schwartz  GJMehta  RHWenig  BLShaligram  CPortugal  LE Salvage treatment for recurrent squamous cell carcinoma of the oral cavity.  Head Neck.2000;22:34-41.PubMedGoogle Scholar
Shah  JPHaribhakti  VLoree  TRSutaria  P Complications of the pectoralis major myocutaneous flap in head and neck reconstruction.  Am J Surg.1990;160:352-355.PubMedGoogle Scholar
Bengtson  BPSchusterman  MABoldwin  BJ  et al Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction.  Am J Surg.1993;166:326-330.PubMedGoogle Scholar
Department of Veterans Affairs Laryngeal Study Group Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer.  N Engl J Med.1991;324:1685-1690.PubMedGoogle Scholar
Lefebvre  JLChevalier  DLuboinski  BKirkpatrick  ACollette  LSahmeud  TEORTC Head and Neck Cancer Cooperative Group Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial.  J Natl Cancer Inst.1996;88:890-899.PubMedGoogle Scholar
Weisman  ARRobbins  KT Management of the neck in patients with head and neck cancer treated by concurrent chemotherapy and radiation.  Otolaryngol Clin North Am.1998;31:773-784.PubMedGoogle Scholar
Gehanno  PDepondt  JGuedon  CKebaili  CKoka  V Primary and salvage surgery for cancer of the tonsillar region: a retrospective study of 120 patients.  Head Neck.1993;15:185-189.PubMedGoogle Scholar
American Joint Committee on Cancer Purposes and principles of staging.  In:  AJCC Cancer Staging Manual.5th ed. Philadelphia, Pa: Lippincott-Raven; 1997. Google Scholar
Sassler  AMEsclamado  RMWolf  GT Surgery after organ-preservation therapy: analysis of wound complications.  Arch Otolaryngol Head Neck Surg.1995;121:162-165.PubMedGoogle Scholar
Kowalski  LPHashimoto  IMagrin  J End results of 114 extended "commando" operations for retromolar trigone carcinoma.  Am J Surg.1993;166:374-379.PubMedGoogle Scholar
Girod  DAMcCulloch  TMTsue  TTWeymuller  EA  Jr Risk factors for complications in clean-contaminated head and neck surgical procedures.  Head Neck.1995;17:7-13.PubMedGoogle Scholar
Kowalski  LPAlcantara  PSMagrin  JParise Junior  O A case-control study on complications and survival in elderly patients undergoing major head and neck surgery.  Am J Surg.1994;168:485-490.PubMedGoogle Scholar
Clayman  GLEicher  SASicord  MWRazmpa  EGoepfert  H Surgical outcomes in head and neck cancer patients 80 years of age and older.  Head Neck.1998;20:216-223.PubMedGoogle Scholar
Corey  JPCaldarelli  DDHutchinson  JC  Jr  et al Surgical complications in patients with head and neck cancer receiving chemotherapy.  Arch Otolaryngol Head Neck Surg.1986;112:437-439.PubMedGoogle Scholar
Lavertu  PBonafede  JPAdelstein  DJ  et al Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer.  Arch Otolaryngol Head Neck Surg.1998;124:401-406.PubMedGoogle Scholar
Original Article
December 2003

Postoperative Complications After En Bloc Salvage Surgery for Head and Neck Cancer

Author Affiliations

From the Head and Neck Surgery and Otorhinolaryngology Department, Hospital do Câncer A. C. Camargo, São Paulo, Brazil. The authors have no relevant financial interest in this article.

Arch Otolaryngol Head Neck Surg. 2003;129(12):1317-1321. doi:10.1001/archotol.129.12.1317

Objective  To analyze the frequency of and risk factors for postoperative complications after en bloc salvage surgery for head and neck cancer.

Design  Retrospective cohort study.

Setting  Patients were evaluated from February 7, 1990, to November 17, 1999, in a tertiary cancer center hospital.

Patients  Consecutive sample of 124 patients from the hospital database. Only patients with recurrent head and neck squamous cell carcinoma undergoing en bloc salvage resection were eligible for the study.

Main Outcome Measures  We analyzed the frequency of and risk factors for complications after salvage surgery.

Results  The tumor location was the lip in 6 patients, oral cavity in 55, oropharynx in 31, larynx in 24, and hypopharynx in 8. Previous treatment was surgery alone in 20 patients, radiotherapy alone in 68, surgery and radiotherapy in 21, and radiotherapy and chemotherapy in 14. An additional patient received chemotherapy alone before salvage surgery. The clinical stage of the recurrent tumor was I or II in 23 patients and III or IV in 101 patients. Postoperative complications occurred in 66 patients (53.2%). Fifty-three patients (42.7%) had minor complications, and 23 patients (18.5%) had major ones. There were 4 postoperative deaths (3.2%). The major factor associated with the overall occurrence of postoperative complications was the clinical stage of the recurrent tumor (P = .02). The occurrence of minor complications correlated with the previously treated site, with complications occurring more often in patients undergoing locoregional vs local treatment (P = .04). Major complications were associated with the time between initial treatment and salvage surgery (P = .05).

Conclusions  Salvage surgery can be performed with acceptable rates of postoperative complications. The clinical stage of the recurrent tumor and the previous site treated were the 2 major factors associated with the occurrence of postoperative complications.