COMPARISON OF SURGICAL COMPLICATIONS AFTER ORGAN-PRESERVATION THERAPYIN PATIENTS WITH STAGE-III OR STAGE-IV SQUAMOUS-CELL HEAD AND NECK-CANCER

Objective: To determine the incidence of minor and major complications in patients with squamous cell carcinoma of the upper aerodigestive t ract who require surgical salvage or planned neck dissection after an initial treatment regimen with radiotherapy or concurrent chemoradioth erapy for organ preservation. Design: The medical records of 100 patie nts treated in a phase 3 trial comparing radiotherapy alone with concu rrent chemoradiotherapy for stage III and IV head and neck squamous ce ll carcinoma were reviewed. Fifty-four patients underwent 59 surgical procedures. Twenty nine planned neck dissections were performed for pe rsistent neck disease or initial stage NZ or greater. For persistent o r recurrent disease at the primary site, 30 salvage operations were pe rformed.Setting: Academic tertiary care referral center. Results: Comp lications occurred in 15 (46%) of the 13 procedures in the radiation-o nly group and 12 (46%) of the 26 procedures in the chemoradiotherapy g roup. Major complications occurred in 4 (12%) of the procedures in the radiation-only group and 3 (12%) of the procedures in the chemoradiot herapy group. The incidence of minor complications was 33% and 35% in the radiation-only and chemoradiotherapy groups, respectively. The maj or complication rate for salvage operations did not differ between the radiation-only and chemoradiotherapy groups (16% and 27%, respectivel y; P=.79 by chi(2) test). The incidence of major complications in plan ned neck dissections was 7% of the radiation-only group and 0% of the chemoradiotherapy group. Conclusions: After radiation or concurrent ch emoradiotherapy, surgery can be performed with an acceptable rate of m ajor complications. Adding chemotherapy did not increase the incidence of surgical complications. These results differ from other reports in the literature.