OP173: Predictive factors of morbidity and survival outcomes after salvage surgery in head and neck cancers

Abstract

Purpose Treatment of loco-regional recurrences in head and neck is associated with increased complications. Purpose of study is to evaluate outcome of salvage surgery and to identify the predictors of morbidity after such surgery. Materials and method Retrospective analysis of 150 consecutive cases of salvage surgery.The study period was between 2004 and 2011.Operative and clinical records were analyzed. Morbidity in terms of immediate and long term complications such as local wound complications, systemic complications, flap related complications, post operative death, feeding tube and tracheostomy tube dependence were studied. Oncological outcome in terms of subsequent recurrence, patterns of recurrence and survival were analyzed. Univariate and Multi variate Analysis and Kaplan Meir survival studies were performed. Results 70 patients had oral cavity tumors and 37 patients had laryngopharyngeal tumors. 117 patients received previous radiotherapy, 47 receives previous chemoradiotherapy and 38 patients had prior surgery alone.44 patients had salvage surgery of the neck and the primary areas, 73 had primary salvage alone and 33 had neck salvage. Recurrence T stage T4a-47(31%), T3–17(11%). Recurrence N stage N2b 21(14%), N2a 9(6%). Wound complications are seen in 28% of pts, flap complications – 12% of patients. Study has 44% pts with tube dependence. Free flap reconstruction is done in 54(36%) patients, regional/local flap is used in 36(24%) patients. Mean duration of hospital stay is 13 days and ICU stay is 3.4 days. Previous RT (p = 0.018), previous Chemotherapy (0.021) and type of salvage surgery (Combined primary and neck vs either) (p = 0.002) was significant for wound complications in univariate analysis. On multivariate analysis The type of surgery remained significant for wound complications (p = 0.011, Odds Ratio −2.751, 95%CI 1.26–5.98). 2 year post salvage overall survival is 48.7%. 2 year post salvage disease free survival is 45%. The mean follow up period was 20 months. Conclusion Salvage surgery has resulted in Good survival outcomes.Previous RT, previous chemotherapy and type of salvage surgery are significant predictors for wound complications. In salvage cases, combining primary surgery with neck surgery will result in significant increase in morbidity.