Surgical salvage of advanced recurrent head and neck squamous cell carcinoma

Post-treatment recurrence constitutes a major cause of poor prognosis in head and neck squamous cell carcinomas (HNSCC). It has been suggested that cancer cell residual, tumor seeding and multiple hit theory are related to the relapse of tumor after certain treatment modalities such as surgery and/or chemoradiation therapies are given. Cancer stem cells (CSCs) may also become a major origin from which a relapsed tumor occurs. No matter what treatment modalities the patients receive, post-treatment recurrence can be categorized into local recurrence, regional recurrence and locoregional recurrence, depending on the site and location of the tumor regrowth. Among various options for managing the recurrent HNSCC, salvage surgical operation is a good treatment of choice if indications are properly selected. For the surgical removal of an advanced HNSCC, a surgeon has to run a high risk of intra- and post-operative morbidities and mortalities, because the relapsed tumor is often large and extensive with involvement of major structures and/or organs in the head and neck region. To screen the possible and thus suitable candidates for surgical salvage, a thorough assessment of patient's general condition, resectablity of the tumor and available methods for reconstruction of major defects incurred from tumor removal has to be carried out. Expertise for tumor resection and oncoplastic surgery is indispensible for a successful surgical salvage. For managing associated perioperative problems, a MDT team is definitely needed to set up an ideal treatment plan for the whole process of salvage surgery. If the candidates for salvage surgical operation are properly selected and the perioperative problems are correctly managed, the salvage surgery for advanced HNSCCs can be implemented.

Publication History

Publication Date:
18 April 2018 (online)