Palliative Reconstruction for the Management of Incurable Head and Neck Cancer

Amar Miglani; Viraj M. Patel; Carrie S. Stern; Katie E. Weichman; Missak Haigentz Jr.; Thomas J. Ow; Evan S. Garfein

doi:10.1055/s-0035-1568156

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2016; 32(03): 226-232
DOI: 10.1055/s-0035-1568156

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Palliative Reconstruction for the Management of Incurable Head and Neck Cancer

Authors

Amar Miglani

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Viraj M. Patel

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Carrie S. Stern

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Katie E. Weichman

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Missak Haigentz Jr.

²Division of Oncology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York

³Department of Otorhinolaryngology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Thomas J. Ow

³Department of Otorhinolaryngology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York

⁴Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Evan S. Garfein

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York

Abstract

Background Surgical management of head and neck cancer is resource intensive and physiologically demanding. In patients with incurable disease, although the indications for surgery are not well defined, palliative benefit can be significant. The goal of this investigation was to compare outcomes of patients who underwent resection and reconstruction of head and neck cancer with curative intent with those who underwent similar procedures with palliative intent.

Methods A retrospective review of patients who underwent reconstruction for head and neck cancer between 2008 and 2014 was conducted. Patients were divided into curative and palliative groups. Outcomes assessed included postoperative complications and survival.

Results A total of 147 patients who underwent 156 operations met inclusion criteria (27 palliative and 129 curative). In both cohorts, the most common histology was squamous cell carcinoma (SCC) and the most common primary tumor site was the oral cavity. There was no significant difference between the cohorts in the rates of systemic and reconstructive complications, postoperative hospital length of stay, 30-day mortality, and flap survival. Overall survival in palliative patients was significantly shorter compared with curative patients (median OS, 6.2 months vs. 56.1 months, respectively; p < 0.0001). Among patients undergoing palliative surgery, patients without carotid involvement and those with non-SCC were significantly more likely to have longer survival.

Conclusion Surgical resection with reconstruction is possible in head and neck oncologic patients undergoing palliative treatment. Palliative patients have similar short-term outcomes when compared with patients undergoing resection for curative intent. Quality-of-life and economic implications of these approaches deserve closer scrutiny.

Keywords

palliative surgery - head and neck reconstruction - head and neck cancer - palliative reconstruction

Full Text

References

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