• head and neck cancer
• head and neck surgery
• radiotherapy
• recurrence
• salvage surgery

IMPORTANCE The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits.
OBJECTIVE To identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting.
DESIGN, SETTING, AND PARTICIPANTS The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC between January 1, 1990, and March 31, 2020, were retrospectively reviewed. The primary endpoint was OS from salvage treatment to last follow-up or death. Secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Univariate and multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications.
RESULTS With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complication.
CONCLUSIONS AND RELEVANCE When discussing with the patients and the caregivers salvage surgery for radiorecurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.