Page 96 - Read Online

based on our own experience in treating advanced microsurgical techniques are used.
recurrent tumor with neck involvement, that the major
complication rate may be significantly different when Financial support and sponsorship
only a local recurrence is surgically treated or by contrast Nil.
when a loco-regional or regional recurrence with neck
involvement is managed [Figure 3]. Most of our recurrent Conflicts of interest
patients have been previously treated by primary surgery There are no conflicts of interest.
with local excision and cervical neck dissection followed
or not by loco-regional radiotherapy. The effect of REFERENCES
prior operation and/or irradiation is determinant in
the absence of anatomical layers or boundaries, which 1. Lin YC, Hsiao JR, Tsai ST. Salvage surgery as the primary treatment for
makes salvage surgery of the neck completely different recurrent oral squamous cell carcinoma. Oral Oncol 2004;40:183-9.
from that performed in the primary treatment. Even, 2. Gleich LL, Ryzenman J, Gluckman JL, Wilson KM, Barrett WL,
it is not uncommon among our recurrent patients to Redmond KP. Recurrent advanced (T3 or T4) head and neck
encounter advanced tumors in which diffuse invasion is squamous cell carcinoma: is salvage possible? Arch Otolaryngol Head
present, with invasion of major vascular structures such 3. Neck Surg 2004;130:35-8.
Schwartz GJ, Mehta RH, Wenig BL, Shaligram C, Portugal LG. Salvage
as the internal jugular vein and surrounding musculature, treatment for recurrent squamous cell carcinoma of the oral cavity.
which subsequently makes surgery much more difficult Head Neck 2000;22:34-41.
and hazardous, with potential severe complications such 4. Kowalski LP. Results of salvage treatment of the neck in patients with
as massive bleeding from big cervical vessels. oral cancer. Arch Otolaryngol Head Neck Surg 2002;128:58-62.
5. Agra IM, Carvalho AL, Ulbrich FS, de Campos OD, Martins EP, Magrin
J, Kowalski LP. Prognostic factors in salvage surgery for recurrent oral
Thus, based on previous series and on our own experience, and oropharyngeal cancer. Head Neck 2006;28:107-13.
we believe that: (1) overall complication rate for salvage 6. Koo BS, Lim YC, Lee JS, Choi EC. Recurrence and salvage treatment of
surgery is higher than that for primary surgery; (2) major squamous cell carcinoma of the oral cavity. Oral Oncol 2006;42:789-94.
complications rate does not seem to be statistically 7. Brown JS, Blackburn TK, Woolgar JA, Lowe D, Errington RD, Vaughan
different for salvage surgery; and (3) major complication ED, Rogers SN. A comparison of outcomes for patients with oral
squamous cell carcinoma at intermediate risk of recurrence treated
rate and postoperative mortality from salvage surgery by surgery alone or with post-operative radiotherapy. Oral Oncol
does not seem to differ from that observed for advanced 2007;43:764-73.
stages III/IV primary OSCC, but this should not be 8. Liao CT, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Chen
extensible to early stage tumors (I/II) treated primarily by IH, Huang SF, Cheng AJ, Yen TC. Salvage therapy in relapsed squamous
surgery, in which major complications are being expected cell carcinoma of the oral cavity: how and when? Cancer 2008;112:94-
103.
in a lower rate. 9. Lim YC, Choi EC. Surgery alone for squamous cell carcinoma of the
oral cavity: survival rates, recurrence patterns, and salvage treatment.
Also, the influence of long-term radiation toxicity derived Acta Otolaryngol 2008;128:1132-7.
from its postoperative administration in the primary 10. Kernohan MD, Clark JR, Gao K, Ebrahimi A, Milross CG. Predicting
treatment and/or following salvage surgery may determine the prognosis of oral squamous cell carcinoma after first recurrence.
Arch Otolaryngol Head Neck Surg 2010;136:1235-9.
the appearance of xerostomia, osteo-radionecrosis of the 11. Sklenicka S, Gardiner S, Dierks EJ, Potter BE, Bell RB. Survival analysis
jaws or restricted mouth opening and lingual movements, and risk factors for recurrence in oral squamous cell carcinoma: does
which may add its deleterious effects to those derived surgical salvage affect outcome? J Oral Maxillofac Surg 2010;68:1270-5.
from surgery. Even, despite the performance of free 12. Kostrzewa JP, Lancaster WP, Iseli TA, Desmond RA, Carroll
[16]
flap reconstruction, up to 25-50% of the patients may WR, Rosenthal EL. Outcomes of salvage surgery with free flap
require a permanent gastrotomy because of feeding reconstruction for recurrent oral and oropharyngeal cancer.
Laryngoscope 2010;120:267-72.
impairment, although these considerations concerning 13. Goto M, Hanai N, Ozawa T, Hirakawa H, Suzuki H, Hyodo I, Kodaira
sequelae are beyond the scope of the present paper. T, Ogawa T, Fujimoto Y, Terada A, Kato H, Hasegawa Y. Prognostic
factors and outcomes for salvage surgery in patients with recurrent
In summary, with an overall 26% recurrence rate for OSCC squamous cell carcinoma of the tongue. Asia Pac J Clin Oncol
2016;12:141-8.
despite primary treatment with surgery followed by post- 14. Cooney TR, Poulsen MG. Is routine follow-up useful after combined-
operative radiotherapy, the clinician must be firmly aware modality therapy for advanced head and neck cancer? Arch Otolaryngol
of recurrence, which is mainly a local relapse in more than Head Neck Surg 1999;125:379-82.
47% of the cases, followed by a regional recurrence in 15. Goodwin WJ Jr. Salvage surgery for patients with recurrent squamous
35% and a combined loco-regional relapse in almost 11% cell carcinoma of the upper aerodigestive tract: when do the ends
justify the means. Laryngoscope 2000;110:1-18.
of the cases. While chemotherapy is clearly discouraging 16. Dziegielewski PT, Ho ML, Rieger J, Singh P, Langille M, Harris JR,
and radiotherapy has only been reported to be curative in Seikaly H. Total glossectomy with laryngeal preservation and free flap
no more than a 20%, salvage surgery is the best option for reconstruction: objective functional outcomes and systematic review
the treatment of recurrent OSCC patients, also for those of the literature. Laryngoscope 2013;123:140-5.
with advanced disease, with a mean 5-year overall-survival 17. Zafereo ME, Hanasono MM, Rosenthal DI, Sturgis EM, Lewin JS,
rate of more than 40% of the cases, showing acceptable Roberts DB, Weber RS. The role of salvage surgery in patients
with recurrent squamous cell carcinoma of the oropharynx. Cancer
morbidity and good functional results if reconstructive 2009;115:5723-33.
196 Plast Aesthet Res || Volume 3 || June 24, 2016