SURGICAL MORBIDITY OF NECK DISSECTION AFTER CHEMORADIOTHERAPY IN ADVANCED HEAD AND NECK-CANCER

The use of chemotherapy and irradiation for organ preservation attempt s to eliminate the need for extensive surgery in patients with advance d squamous cell carcinoma of the head and neck (SCCHN). We sought to c haracterize the morbidity of surgery in patients who needed surgery af ter treatment with induction chemotherapy followed by simultaneous che motherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an o rgan preservation approach between July 1991 and December 1994 was com pared with a control group of patients undergoing similar surgical pro cedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no si gnificant difference in the duration of surgery or length of hospitali zation between study patients and matched controls. Our surgical compl ication rate (35.3%) was higher but not statistically different from t hat of the control group, and compared favorably to reports of surgica l morbidity (44% to 61%) in the literature on patients treated with ch emoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ pres ervation study scheme, the preponderance of neck dissections performed , and the limited number of pharyngeal procedures performed.