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Objective: To investigate the clinicopathologic factors associated with neck control and distant metastasis in patients with neck metastases in head and neck squamous cell carcinoma (HNSCC) after postoperative radiation as adjuvant treatment., Methods: Clinicopathologic data of 208 pathologic N+ (pN+ ) patients with HNSCC initially treated with neck dissection and postoperative radiation in Bethune International Peace Hospital of China from January 2004 to December 2009 were reviewed. The clinicopathologic factors, includeding age, sex, primary tumor site, pathologic T and N stage, tumor growth pattern, histological grade, tumor resection margin, size and number of positive lymph node, number of levels with positive lymph node, and extracapsular nodal spread (ECS), were evaluated for their association with neck control and distant metastasis in patients with HNSCC after postoperative radiation. Univariate χ(2) test and multiple stepwise logistic regression model were used for the analysis., Results: Overall 5-year neck control rate after postoperative radiotherapy was 72.6% (151/208), with 84.0% (63/75) for SND, 72.9% (78/107) for MRND, and 38.5% (10/26) for RND, respectively. Univariate analysis showed that neck control after postoperative radiation was related with following factors: primary tumor site, pathologic N stage, size of positive node, number of levels with positive node, number of positive node, and ECS. Pathologic N stage and number of levels with positive lymph node were associated with distant metastasis. Multivariate analysis indicated that ECS was the most significant risk factor for neck metastasis after surgery and postoperative radiotherapy and the number of levels with positive node was the most significant risk factor for distant metastasis., Conclusions: ECS is the most important pathologic factor in planning postoperative adjuvant treatment for pN+ patients with HNSCC, therefore ECS should be evaluated routinely after neck dissection. The value of postoperative radiotherapy in controlling the ECS-related recurrence after surgery is limited. Postoperative concurrent chemoradiotherapy and targeted therapy can be considered in HNSCC patients with ECS.

Objective: To explore the plausibility of laryngeal preservation in salvage surgery of recurrent laryngeal carcinoma., Methods: Comprehensive clinical and radiological assessments on a specific group of patients with recurrent laryngeal cancer and their relapsed tumors were carried out to determine the methods and indications of salvage surgery for preservation of laryngeal functions. Salvage surgery with preservation of larynx was performed in a selective of 36 laryngeal cancer patients with relapsed tumors in their larynges after radiotherapy or partial laryngectomies. All patients were regularly followed up after discharge from the hospital. Postoperative survival was calculated by Kaplan-Meier's method., Results: Among various laryngeal preservation regimens given, a second transoral laser surgery was carried out in 4 cases, horizontal hemilaryngectomy in 4 cases, vertical hemilaryngectomy in 13 cases and Majer-Piquet's operation in 15 cases, respectively. Simultaneous neck dissection was conducted in 18 cases. Postoperative complications were encountered in 6 cases, most common of which were local infection and laryngeal fistula with no hospital mortality and other major morbidities. Five cases with immediate postoperative complications were cured with proper management. The remained one case undergone vertical partial laryngectomy for recurrence after tumor resection via laryngeal fissure received postoperative radiation due to positive surgical margin, and complicated laryngeal atresia and obstruction with loss of his laryngeal functions. Local recurrence was observed in 5 cases and simultaneous locoregional recurrence was seen in 1 case, with the resulting local control rate of 83.3% (30/36). The 3-year postoperative survival rate was 80.6%. The cause of death was tumor recurrence in 3 cases, distant metastasis in 3 cases and non-tumor-associated disease (heart attack) in 1 case, respectively., Conclusions: Salvage surgery with laryngeal preservation can be carried out in the selected cases with early or locally-confined recurrent lesions within the larynx, on the condition that the recurrent tumors be assessed thoroughly and indications for associated surgical techniques be evaluated properly.

Objective: To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone., Methods: A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model., Results: Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15(20.8%) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7%, 22.2% and 6.9%, respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45.8% and 36.1%, respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy, surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphotic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion., Conclusions: Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.

Objective: To explore the related issues concerning salvage surgery for stomal recurrence (SR) after total laryngectomy., Methods: A retrospective study was conducted to analyse the clinical data from 36 patients suffering from SR after total laryngectomy, who were treated by salvage surgery from January 1990 to January 2006. Some related issues concerning salvage surgery for SR were studied and analysed, which include preoperative evaluations, surgical approaches and techniques, management of perioperative complications and outcomes of treatment., Results: After careful preoperative evaluations and predictions, a complete resection of tumor was achieved in 33 out of 36 SR patients. Two patients sacrificed because of ruptures of major vessels including the common carotid eaters and the innominate artery 3 weeks and 2 months after the operation. The overall 1-year, 2-year and 3-year survival of this group of patients were 68.8%, 42.8% and 12.5%, respectively. Besides, postoperative complications comprise 23 cases of hypothyroidisms, 6 cases of wound infection and saliva leakage, 8 cases of donor site complications (including dehiscence of wound in 3 cases, chest wall hematomas in 4 cases, and tumor seeding in 1 case), and hypopharyngeal stenosis in 4 cases, all of which were properly and promptly managed with uneventful outcomes., Conclusions: SR after total laryngectomy is a dangerous and complicated status with poor prognosis. For the purpose of saving or elongating the patients's lives, the salvage surgery needs to be done on the condition that indicated candidates are properly selected, preoperative evaluations carefully conducted, and perioperative abnormal conditions unerroneously delt with.