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Digital archive of theses discussed at the University of Pisa

 

Thesis etd-10132020-093727


Thesis type
Tesi di specializzazione (4 anni)
Author
LOCATELLO, LUCA GIOVANNI
URN
etd-10132020-093727
Thesis title
The risks and benefits of salvage surgery for radiorecurrent head and neck cancer: a retrospective clinical study
Department
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Course of study
OTORINOLARINGOIATRIA
Supervisors
relatore Prof. Gallo, Oreste
correlatore Dott. Dolivet, Gilles
Keywords
  • recurrence
  • radiotherapy
  • head and neck surgery
  • head and neck cancer
  • salvage surgery
Graduation session start date
17/11/2020
Availability
Withheld
Release date
17/11/2090
Summary
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.
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