title: Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function.
abstract: BACKGROUND
  Surgery after (chemo)radiation (RCTX/RTX) is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemo)radiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS) was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population.
  
  
  RESULTS
  21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female) for salvage (10/21), palliation (4/21), or functional rehabilitation (7/21). Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19%) (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas) and major donor site complications in 1 pt (wound dehiscence). Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%). A decline of KPS was noted in only one patient.
  
  
  CONCLUSIONS
  We conclude that within this (chemo)radiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.
authors: University of Heidelberg, Department of Otolaryngology-Head and Neck Surgery, Heidelberg, Germany. Christian.Simon@med.uni-heidelberg.de
authors: Christian
authors: C
authors: Simon
authors: Cem
authors: C
authors: Bulut
authors: Philippe A
authors: PA
authors: Federspil
authors: Marc W
authors: MW
authors: Münter
authors: Katja
authors: K
authors: Lindel
authors: Zazie
authors: Z
authors: Bergmann
authors: Serkan
authors: S
authors: Sertel
authors: Sarah
authors: S
authors: Leitzbach
authors: Peter K
authors: PK
authors: Plinkert
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000175:diagnosis*; D019651:Plastic Surgery Procedures / Q000379:methods; D016879:Salvage Therapy / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome