The surgical management of head and neck sarcoma: The Newcastle experience.
BACKGROUND
Head and neck sarcomas are rare and difficult to manage surgically. Factors that influence the prognosis include the type and grade of tumour, resection margins, the anatomical site and patient-specific parameters. We review our experience as plastic surgeons working in a bone and soft-tissue tumour multidisciplinary team (MDT) in managing these tumours surgically.


METHODS
Data on all patients with sarcoma of the head or neck managed surgically from 2004 to 2015 was reviewed. Demographics, surgical details and outcomes were analysed.


RESULTS
Forty-nine patients underwent surgery for sarcoma of the head or neck. The mean age at presentation was 53.1 years (range 0.5-92). Histological diagnosis was varied. Leiomyosarcoma (n = 6), angiosarcoma (n = 9), synovial sarcoma (n = 4), sarcoma of no specific type (n = 5) and rhabdomyosarcoma (n = 5) were the most frequently seen tumours. All sarcomas were treated by wide excision. Excision margins were histologically complete in the vast majority (n = 43). Reconstruction was undertaken as follows: direct closure (n = 12), local flap ± skin graft (n = 12), free tissue transfer (n = 21), pedicled flap ± skin graft (n = 3) and skin graft (n = 1). Twelve patients received adjuvant chemotherapy and fifteen patients received adjuvant radiotherapy. Eleven patients developed local recurrence and 10 patients developed metastasis. Twelve patients died of their disease: mean survival period was 17 months (range 8-28 months). The mean duration of follow-up was 78 months (range 18-137 months). Estimated 5-year disease-specific survival for this cohort was 72% and overall estimated survival was 61% (Kaplan-Meier equation).


CONCLUSIONS
Head and neck sarcomas are rare and challenging to manage. Successful outcomes can be achieved by early, aggressive resection and appropriate reconstruction within the specialist MDT setting.
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, Ne1 4LP, United Kingdom.
R W F
RW
Breakey
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, Ne1 4LP, United Kingdom. Electronic address: patcrowley01@gmail.com.
T P
TP
Crowley
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, Ne1 4LP, United Kingdom.
I B
IB
Anderson
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, Ne1 4LP, United Kingdom.
R H
RH
Milner
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, Ne1 4LP, United Kingdom.
M
M
Ragbir
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
Free tissue transfer; Head and neck; Oncology; Reconstruction; Sarcoma