title: Postoperative complications after en bloc salvage surgery for head and neck cancer.
abstract: OBJECTIVE
  To analyze the frequency of and risk factors for postoperative complications after en bloc salvage surgery for head and neck cancer.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients were evaluated from February 7, 1990, to November 17, 1999, in a tertiary cancer center hospital.
  
  
  METHODS
  Consecutive sample of 124 patients from the hospital database. Only patients with recurrent head and neck squamous cell carcinoma undergoing en bloc salvage resection were eligible for the study.
  
  
  METHODS
  We analyzed the frequency of and risk factors for complications after salvage surgery.
  
  
  RESULTS
  The tumor location was the lip in 6 patients, oral cavity in 55, oropharynx in 31, larynx in 24, and hypopharynx in 8. Previous treatment was surgery alone in 20 patients, radiotherapy alone in 68, surgery and radiotherapy in 21, and radiotherapy and chemotherapy in 14. An additional patient received chemotherapy alone before salvage surgery. The clinical stage of the recurrent tumor was I or II in 23 patients and III or IV in 101 patients. Postoperative complications occurred in 66 patients (53.2%). Fifty-three patients (42.7%) had minor complications, and 23 patients (18.5%) had major ones. There were 4 postoperative deaths (3.2%). The major factor associated with the overall occurrence of postoperative complications was the clinical stage of the recurrent tumor (P =.02). The occurrence of minor complications correlated with the previously treated site, with complications occurring more often in patients undergoing locoregional vs local treatment (P =.04). Major complications were associated with the time between initial treatment and salvage surgery (P =.05).
  
  
  CONCLUSIONS
  Salvage surgery can be performed with acceptable rates of postoperative complications. The clinical stage of the recurrent tumor and the previous site treated were the 2 major factors associated with the occurrence of postoperative complications.
authors.affiliation: Head and Neck Surgery and Otorhinolaryngology Department, Hospital do Câncer A.C. Camargo, Rua Professor Antônio Prudente 211, 01509-900 São Paulo, Brazil.
authors.forename: Ivan M G
authors.initials: IM
authors.lastname: Agra
authors.forename: Andre L
authors.initials: AL
authors.lastname: Carvalho
authors.forename: Everton
authors.initials: E
authors.lastname: Pontes
authors.forename: Olimpio D
authors.initials: OD
authors.lastname: Campos
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Ulbrich
authors.forename: Jose
authors.initials: J
authors.lastname: Magrin
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects* / Q000379:methods; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome