SURGERY AFTER ORGAN PRESERVATION THERAPY - ANALYSIS OF WOUND COMPLICATIONS

Objective: To determine the incidence and risk factors for the develop ment of major wound complications in patients with squamous cell cance r of the head and neck that require surgical salvage after an initial treatment regimen of induction chemotherapy and definitive radiation t herapy for organ preservation. Design: Retrospective survey. Setting: Academic tertiary care referral center. Patients and Intervention: The medical records of 96 patients treated with induction chemotherapy fo llowed by definitive radiation therapy were reviewed; 18 of these pati ents requiring a surgical salvage procedure after completing chemother apy and radiation therapy and these constituted the study group. Main Outcome Measures: Major wound complications. Results: Major wound comp lications occurred in 11 (61%) of the 18 patients. Surgical salvage wi thin I year of initial treatment had a 77% incidence of major wound co mplications vs a 20% incidence if performed 1 year after intial treatm ent. The mean time to resolution of fistulae and flap necrosis was 7.7 months. Two deaths were attributed to major wound complications: one patient had a carotid blowout; one had postoperative pneumonia. Conclu sions: Salvage surgical procedures performed after induction chemother apy and definitive radiation therapy have a high rate of major wound c omplications. This should be considered when assessing organ preservat ion treatment strategies.