Usefulness and safety of salvage surgery with reconstruction for recurrent head and neck cancer with a history of reconstruction surgery and radiation therapy.

BACKGROUND

Salvage surgery is one of the treatment options for recurrent metastatic head and neck cancer (RMHNC). Salvage surgery with reconstruction for patients with a history of reconstructive surgery and radiation therapy (RT) is especially difficult and carries a high risk of complications.

METHODS

This study included patients with RMHNC who had a history of reconstructive surgery and RT. The prognosis and complications were evaluated by dividing patients into those who underwent salvage surgery with reconstruction and those who underwent non-surgical treatments.

RESULTS

Fifty-seven patients were enrolled. The overall survival (OS) of the salvage surgery with reconstruction group was better than that of the non-surgical treatment groups (median OS; 50.6 months vs. 21.6 months, p = 0.0373), but the progression-free survival (PFS) was similar (median PFS; 14.5 months vs. 12.9 months, p = 0.48). The salvage surgery with reconstruction group also showed a better prognosis than the immune checkpoint inhibitor (ICI) group (median OS; 50.6 months vs. 30.9 months, p = 0.209). In the salvage surgery with reconstruction group, 85.8 % of cases experienced postoperative complications, while in the patients who underwent non-surgical treatments, 58.8 % experienced adverse events (p = 0.0724). There were no cases of Grade IIIb or higher that required general anesthesia.

CONCLUSION

Salvage surgery with reconstruction showed a better prognosis than other non-surgical treatments, including ICI. Furthermore, with careful case selection and thorough postoperative care, salvage surgery with reconstruction can be performed relatively safely without any serious complications.