Minimizing complications in salvage head and neck oncological surgery following radiotherapy and chemo-radiotherapy

• Published in: Current opinion in otolaryngology & head and neck surgery Vol. 19; no. 2; pp. 125 - 131
• Main Authors: Pang, Leo, Jeannon, Jean-Pierre, Simo, Ricard
• Format: Journal Article
• Language: English
• Published: United States 01-04-2011
• Subjects: Antibiotic Prophylaxis; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Combined Modality Therapy; Cooperative Behavior; Humans; Interdisciplinary Communication; Laryngectomy - methods; Lymphatic Metastasis - pathology; Methicillin-Resistant Staphylococcus aureus; Neck Dissection - methods; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Otorhinolaryngologic Neoplasms - drug therapy; Otorhinolaryngologic Neoplasms - pathology; Otorhinolaryngologic Neoplasms - radiotherapy; Otorhinolaryngologic Neoplasms - surgery; Patient Care Team; Postoperative Care - methods; Postoperative Complications - prevention & control; Reoperation; Salvage Therapy - adverse effects; Salvage Therapy - methods; Staphylococcal Infections - prevention & control; Surgical Flaps; Surgical Wound Infection - prevention & control; Survival Rate
• ISSN: 1068-9508; 1531-6998
• DOI: 10.1097/moo.0b013e3283440ee3

The term salvage surgery denotes oncological surgery after failed radiotherapy or chemoradiotherapy (CRT). Salvage surgery is a high-risk endeavour as it carries a significant risk of complications. The purpose of this review is to assess the ways in which complications from salvage surgery can be prevented and minimized. This is a complex subject and complications are often multifactorial and interrelated. There are many aspects that can be discussed; however, to address each of them individually would be impossible and beyond the scope of this article. We will, therefore, focus this review on the most relevant aspects to current practice for head and neck surgeons.
Salvage surgery after failure of radiotherapy and CRT remains controversial and many aspects still lack evidence. Many patients with recurrent cancer are not suitable for salvage surgery due to severe co-morbidities or disease progression. Salvage surgery is best carried out in tertiary centres by experienced multidisciplinary teams. Preoperative assessment and evaluation is critical to success and to minimize complications. Surgical principles include single incisions, delicate tissue handling, use of frozen sections, adopting a critical approach to neck dissections and the use of flaps, secondary surgical voice restoration for laryngectomies and appropriate postoperative care.
This review emphasizes the importance of a multidisciplinary approach by experienced teams, the centralization of resources and teams, a structured and thorough patient assessment, surgical planning and a systematic attention to detail when addressing patients undergoing salvage surgery.