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Review
. 2014 Dec;34(6):382-8.

Salvage surgery for locoregional recurrences of advanced pharyngolaryngeal squamous cell carcinoma after organ preservation failure

I López Delgado  1 , J Riestra Ayora  1 , O Arenas Brítez  1 , I García López  1 , T Martínez Guirado  1 , B Scola Yurrita  1
Affiliations
Review

Salvage surgery for locoregional recurrences of advanced pharyngolaryngeal squamous cell carcinoma after organ preservation failure

I López Delgado et al. Acta Otorhinolaryngol Ital. 2014 Dec.

Abstract
in English, Italian

Organ preservation treatment for advanced head and neck squamous cell carcinoma is associated with poor outcomes due to locoregional recurrences. Salvage surgery is the main therapeutic option for some of these patients. The aim of this study was to analyse the results of salvage surgery for advanced pharyngolaryngeal squamous cell carcinoma previously treated with radiochemotherapy. We performed a retrospective study on 38 patients (36 men, 2 women). The median age at diagnosis was 60 years with a mean follow-up period of 49.8 months. Recurrences were diagnosed at a mean of 395 days after finalising organ preservation treatment. Patients went under different salvage surgeries, including 22 total laryngectomies, 6 partial laryngectomies (3 transoral laser surgeries and 3 opened surgeries), 8 functional neck dissections and 2 tongue base surgeries. Nineteen patients had no postoperative complications after a mean hospital stay of 2 weeks. However, 5 patients died of significant recurrent bleedings. There were 4 salivary fistulas that responded to conservative management, while 7 patients had important pharyngostomas that required reconstruction with either regional or free flaps. The mean hospital stay was of 61.60 days for all patients. Five-year overall survival from diagnosis, overall survival after salvage surgery and survival after salvage surgery were 44.20, 37.90 and 45.70%, respectively. In summary, we conclude that salvage surgery is an optimal treatment for pharyngolaryngeal and regional recurrences and provides improvement in locoregional control and survival, despite the severe complications.

Il trattamento con protocollo di preservazione d'organo per i carcinomi squamocellulari avanzati del distretto testa-collo è associato a una bassa sopravvivenza a causa delle recidive locoregionali. Per alcuni di questi pazienti la chirurgia di salvataggio è la principale opzione terapeutica. L'obiettivo di questo studio è stato quello di analizzare i risultati della chirurgia di salvataggio per i carcinomi faringolaringei a cellule squamose trattati in precedenza con radio-chemioterapia. Abbiamo effettuato uno studio retrospettivo su 38 pazienti (36 uomini, 2 donne). L'età mediana alla diagnosi è stata di 60 anni, con un periodo di follow-up medio di 49,8 mesi. Le recidive sono state diagnosticate dopo una media di 395 giorni dal trattamento con preservazione d'organo. I pazienti sono stati sottoposti a diversi tipi di chirurgia di salvataggio, fra i quali 22 laringectomie totali, 6 laringectomie parziali (3 con chirurgia laser transorale e 3 con chirurgia open), 8 svuotamenti laterocervicali funzionali e 2 interventi sulla base della lingua. Dopo una permanenza media in ospedale di 2 settimane, 19 pazienti non hanno avuto complicanze postoperatorie. Tuttavia 5 pazienti sono deceduti per importanti sanguinamenti nel postoperatorio, 4 hanno presentato fistole salivari che hanno risposto positivamente ad una gestione conservativa, mentre 7 pazienti hanno avuto delle importanti fistole faringee che hanno richiesto ricostruzioni con lembi regionali o liberi. La permanenza media in ospedale è stata di 61,60 giorni. L'overall survival a 5 anni dalla diagnosi, l'overall survival dopo chirurgia di salvataggio e il disease specific survival dopo chirurgia di salvataggio sono stati rispettivamente del 44,2, 37,9 e 45,7%. Possiamo concludere che la chirurgia di salvataggio risulta un trattamento ottimale per le recidive faringolaringee e regionali e determina un miglioramento nel controllo regionale e nella sopravvivenza, nonostante le gravi complicanze associate.

Keywords: Organ preservation; Pharyngocutaneous fistula; Salvage surgery; Total laryngectomy.

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Figures

Fig. 1.
Fig. 1.
Resection margins.
Fig. 2.
Fig. 2.
Overall survival from diagnosis, overall survival after salvage surgery and survival after salvage surgery.
See this image and copyright information in PMC

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