Clinical outcome of salvage neck dissections in head and neck cancer in relation to initial treatment, extent of surgery and patient factors

Clin Otolaryngol. 2017 Jun;42(3):693-700. doi: 10.1111/coa.12818. Epub 2017 Jan 24.

Abstract

Objective: Salvage surgery has a higher complication rate compared to primary surgical treatment. We evaluated clinical outcome of salvage neck dissections in relation to initial treatment modality, extent of surgery and patient-related factors.

Design: Single institution consecutive case series.

Setting: Tertiary Head and Neck Cancer Centre.

Participants: In all, 87 patients with head and neck squamous cell carcinoma, who underwent salvage neck dissection after initial radiotherapy (n = 30), radiotherapy with carboplatin/5-fluorouracil (n = 43) or radiotherapy with cetuximab (n = 14).

Main outcome measures: Incidence of complications, disease-specific survival.

Results: Complications occurred in 28% of the patients. Multivariate analysis identified extent of neck dissection as the only independent predictor of surgical complications (P = 0.010). Surgical complication rate was 16% after radiotherapy with systemic treatment, and 47% after radiotherapy alone (P = 0.171). The 5-year disease-specific survival was 55%, independent of complications, initial treatment, extent of surgery and patient-related factors.

Conclusion: The only predictor for surgical complications was extent of surgery. Survival was not influenced by complications.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / therapy*
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / diagnosis
  • Head and Neck Neoplasms / secondary
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Incidence
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neck Dissection / methods*
  • Netherlands / epidemiology
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Salvage Therapy*
  • Squamous Cell Carcinoma of Head and Neck
  • Survival Rate / trends
  • Tomography, X-Ray Computed