title: Palliative Reconstruction for the Management of Incurable Head and Neck Cancer.
abstract: BACKGROUND
  Surgical management of head and neck cancer is resource intensive and physiologically demanding. In patients with incurable disease, although the indications for surgery are not well defined, palliative benefit can be significant. The goal of this investigation was to compare outcomes of patients who underwent resection and reconstruction of head and neck cancer with curative intent with those who underwent similar procedures with palliative intent.
  
  
  METHODS
  A retrospective review of patients who underwent reconstruction for head and neck cancer between 2008 and 2014 was conducted. Patients were divided into curative and palliative groups. Outcomes assessed included postoperative complications and survival.
  
  
  RESULTS
  A total of 147 patients who underwent 156 operations met inclusion criteria (27 palliative and 129 curative). In both cohorts, the most common histology was squamous cell carcinoma (SCC) and the most common primary tumor site was the oral cavity. There was no significant difference between the cohorts in the rates of systemic and reconstructive complications, postoperative hospital length of stay, 30-day mortality, and flap survival. Overall survival in palliative patients was significantly shorter compared with curative patients (median OS, 6.2 months vs. 56.1 months, respectively; p < 0.0001). Among patients undergoing palliative surgery, patients without carotid involvement and those with non-SCC were significantly more likely to have longer survival.
  
  
  CONCLUSIONS
  Surgical resection with reconstruction is possible in head and neck oncologic patients undergoing palliative treatment. Palliative patients have similar short-term outcomes when compared with patients undergoing resection for curative intent. Quality-of-life and economic implications of these approaches deserve closer scrutiny.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Amar
authors.initials: A
authors.lastname: Miglani
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Viraj M
authors.initials: VM
authors.lastname: Patel
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Carrie S
authors.initials: CS
authors.lastname: Stern
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.affiliation: Division of Oncology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Missak
authors.initials: M
authors.lastname: Haigentz
authors.affiliation: Department of Otorhinolaryngology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ow
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Garfein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome