Issues in Oncologic Surveillance of Patients with Maxillectomy Defects

Abstract

Objectives: (1) Describe locoregional and distant disease recurrence patterns among patients undergoing maxillectomy from 2001-2011 at Cleveland Clinic and UCSF Medical Center. (2) Analyze the pattern of recurrence in this cohort in order to evaluate whether microvascular reconstruction may delay clinical detection of early cancer recurrence. Methods: Retrospective review of patients undergoing inferior, subtotal, or total maxillectomy, with or without reconstruction, for control of malignant disease from 2001-2011 from 2 tertiary centers (Cleveland Clinic and University of California, San Francisco). Results: A total of 76 patients across the 2 institutions met the inclusion criteria for the study. Squamous cell carcinoma was the most prevelant pathologic diagnosis with overall disease progression of 29%. Recurrence at the skull base and regional lymphatic spread were the most common patterns identified (18 and 32%, respectively). Surveillance imaging, rather than direct observation on physical examination, raised suspicion for disease progression in the majority of cases. A total of 9 patients were found to have disease recurrence that could be surgically salvaged, with only 4 patients requiring modification to their reconstruction as part of the salvage operation. Conclusions: Locoregional recurrence of malignancy after partial or total maxillectomy is uncommon, and the suspicion for disease recurrence is significantly more commonly raised on surveillance imaging, rather than on physical examination. Further, locoregional recurrence is rarely amenable to successful surgical salvage. This suggests that primary microvascular reconstruction of maxillectomy defects does not delay diagnosis or treatment of disease recurrence.