Salvage surgery in head and neck cancer: Does it improve outcomes?

Patil, Vijay; Noronha, Vanita; Thiagarajan, Shivakumar; Joshi, Amit; Chandrasekharan, Arun; Talreja, Vikas; Agarwal, Jitendra; Ghosh‐Laskar, Sarbani; Budrukkar, Ashwini; Juvekar, Shashikant; Mahajan, Abhishek; Agarwal, Archi; Purandare, Nilendu; Bhattacharjee, Atanu; D’Cruz, Anil; Chaturvedi, Pankaj; Pai, Prathamesh; Chaukar, Devendra; Prabhash, Kumar

doi:10.1016/j.ejso.2020.01.019

Cited by 32 publications

(34 citation statements)

References 23 publications

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“…Prior institutional studies have investigated the OS outcomes of SS following nonsurgical therapy for head and neck SCC. In the setting of residual or recurrent disease for head and neck malignancies, SS may provide the best OS outcomes, despite the higher risk for complications, yet factors predicting OS remain not well defined 28 . In the setting of SS for head and neck SCC, predictors of regional control and DFS have been laryngeal (compared to pharynx) primary site, greater physical health, local disease recurrence, close/negative surgical margins, and early‐stage disease 29,30 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

et al. 2020

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Objectives/Hypothesis There exists a lack of consensus on the optimal sequence of treatment for many sinonasal malignancies (SNMs). This study compares the overall survival (OS) outcomes for primary surgery (PS) versus salvage surgery (SS) in SNM patients across stage, histology, and primary site. Study Design Retrospective database review. Methods The National Cancer Database was queried for all SNM cases treated with multimodal surgical and nonsurgical therapy between 2004 and 2015. Logistic regression identified predictors of SS. Cox proportional hazards models evaluated predictors of mortality, and Kaplan‐Meier log‐rank test assessed OS outcomes. Results Our SNM cohort consisted of 3,011 patients (PS = 2,804; SS = 207). SS patients had significantly longer postoperative hospital stays (P = .009) and increased rates of 30‐day (P < .001) and 90‐day mortality (P < .001) compared to PS. On multivariate logistic regression, predictors of undergoing SS included sinonasal undifferentiated carcinoma histology (odds ratio = 2.72; 95% confidence interval [CI]: 1.16‐6.66; P = .024). On multivariate Cox proportional hazards analyses among SS patients, late‐stage disease (hazard ratio [HR] = 4.80; 95% CI: 1.46‐15.8; P = .01) and positive surgical margins (HR = 2.31; 95% CI: 1.29‐4.13; P = .005) portended significantly worse OS. In the propensity score–matched cohort controlling for stage and histology, PS had significantly improved OS compared to SS (P = .007). Compared to SS, PS also had improved OS in subgroup analyses for patients with late‐stage disease (P = .026) and squamous cell carcinoma histology (P = .006). Conclusions In our SMN cohort, PS resulted in improved OS outcomes compared to SS independent of stage and histology. Consideration may be given to primary surgical resection for SMN whenever feasible, though a targeted, individualized approach is warranted. Level of Evidence 3 Laryngoscope, 131:E710–E718, 2021

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Section: Discussionmentioning

confidence: 99%

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

et al. 2020

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“…In particular, primary RT has been shown to yield tumor response rates that are non‐inferior to primary surgery with the advantage of organ preservation in various HNCs sub‐types 3,4 . Moreover, the possibility to receive salvage surgery in case of disease persistence could improve patient's outcome 5 . The presence of regional nodal metastases represents a significant adverse prognostic factor in HNCs 6‐11 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of fine‐needle aspiration cytology in detecting cervical node metastasis after radiotherapy: Systematic review and meta‐analysis

et al. 2020

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Purpose To define the accuracy of fine‐needle aspiration cytology (FNAC) in diagnosing persistent or recurrent neck metastases in previously irradiated patients. Methods The study was performed according to the PRISMA‐DTA guidelines. Results A total of 382 FNACs were used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity in detecting malignant nodes were 69.1% (95% CI: 56.3%‐80.7%; I2 = 79.5%) and 84.2% (95% CI: 71.8%‐93.5%; I2 = 87.0%), respectively. Cumulative diagnostic odds ratio (DOR) was 16.54 (95% CI: 4.89‐38.99; I2 = 65.8%), while cumulative positive and negative likelihood ratio (PLR and NLR) were 5.4 (95% CI: 2.3‐11.2) and 0.37 (95% CI: 0.22‐0.54), respectively. Conclusions FNAC alone could not guide the decision to perform a salvage neck dissection in previously irradiated patients, but its results should be assessed in relation to the specific clinical context.

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“…These include the possibility to further improve the outcome if complete tumor resection is achieved, to guide adjuvant therapy by possibly detecting occult lymph node metastases, and to restore areas where extensive tumor growth may lead to defect healing if primary radiotherapy is applied. As other therapeutic approaches including the newly introduced immune-checkpoint inhibition are, at present, restricted to palliative settings and therapeutic response is limited to a fraction of patients, the affected patients need profound guidance regarding the implications of the proposed therapies and their rejection [ 4 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective and prospective studies evaluated the concept of salvage surgery for patients suffering from recurrent head and neck cancer, mostly advocating the use of free flaps for the reconstruction of large tissue defects [ 14 , 15 , 16 , 17 , 18 ]. Although the term “salvage surgery” mostly applies to tumor resections with curative intent in patients with recurrent tumors and a history of previous (radio-) therapies, and consequently lacking alternatives to the surgical approach, the focus of the present study lies on extensive resections of head and neck tumors irrespective of the sequence of prior therapy to exemplify the possibilities and limitations of tumor surgery of the head and neck in general.…”

Section: Discussionmentioning

confidence: 99%

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Moratin

Mrosek

Horn

et al. 2021

Cancers

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Advanced tumors of the head and neck are challenging for the treatment specialist due to the need to synergize oncological and functional requirements. Free flap reconstruction has been established as the standard of care for defects following tumor resection. However, depending on the affected anatomic subsite, advanced tumors may impose specific difficulties regarding reconstruction, especially when full-thickness resection is required. This study aimed to evaluate reconstructive strategies and oncological outcomes in patients with full-thickness resection of the oral cavity. A total of 33 patients with extensive defects due to squamous cell carcinoma of the oral cavity were identified. Indications, reconstructive procedures, and clinical outcome were evaluated. Thirty-two patients (97%) presented locally advanced tumors (T3/T4). Complete tumor resection was achieved in 26 patients (78.8%). The anterolateral thigh flap was the most frequently used flap (47.1%), and the primary flap success rate was 84.8%. The cohort demonstrated a good local control rate and moderate overall and progression-free survival rates. Most patients regained full competence regarding oral alimentation and speech. Full-thickness tumor resections of the head and neck area may be necessary due to advanced tumors in critical anatomic areas. In many cases, radical surgical treatment leads to good oncological results. Free flap reconstruction has been shown to be a suitable option for extensive defects in aesthetically challenging regions.

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Salvage surgery in head and neck cancer: Does it improve outcomes?

Cited by 32 publications

References 23 publications

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

Accuracy of fine‐needle aspiration cytology in detecting cervical node metastasis after radiotherapy: Systematic review and meta‐analysis

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

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