ABSTRACT
OBJECTIVE: To determine the incidence of minor and major complications in patients with squamous cell carcinoma of the upper aerodigestive tract who require surgical salvage or planned neck dissection after an initial treatment regimen with radiotherapy or concurrent chemoradiotherapy for organ preservation. DESIGN: The medical records of 100 patients treated in a phase 3 trial comparing radiotherapy alone with concurrent chemoradiotherapy for stage III and IV head and neck squamous cell carcinoma were reviewed. Fifty-four patients underwent 59 surgical procedures. Twenty-nine planned neck dissections were performed for persistent neck disease or initial stage N2 or greater. For persistent or recurrent disease at the primary site, 30 salvage operations were performed. SETTING: Academic tertiary care referral center. RESULTS: Complications occurred in 15 (46%) of the 33 procedures in the radiation-only group and 12 (46%) of the 26 procedures in the chemoradiotherapy group. Major complications occurred in 4 (12%) of the procedures in the radiation-only group and 3 (12%) of the procedures in the chemoradiotherapy group. The incidence of minor complications was 33% and 35% in the radiation-only and chemoradiotherapy groups, respectively. The major complication rate for salvage operations did not differ between the radiation-only and chemoradiotherapy groups (16% and 27%, respectively; P=.79 by chi2 test). The incidence of major complications in planned neck dissections was 7% of the radiation-only group and 0% of the chemoradiotherapy group. CONCLUSIONS: After radiation or concurrent chemoradiotherapy, surgery can be performed with an acceptable rate of major complications. Adding chemotherapy did not increase the incidence of surgical complications. These results differ from other reports in the literature.
Subject(s)
Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Postoperative Complications/etiology , Adult , Aged , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/radiotherapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Female , Follow-Up Studies , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy , Humans , Laryngectomy , Lymphatic Metastasis , Male , Middle Aged , Neck Dissection , Neoplasm Staging , Postoperative Complications/surgery , Radiotherapy, Adjuvant , Radiotherapy, High-Energy , Reoperation , Salvage TherapyABSTRACT
Surgical treatment of Zenker's diverticulum is controversial because many different procedures exist. We retrospectively reviewed 87 consecutive patients surgically treated for Zenker's diverticulum at a tertiary care institution from 1976 through 1993. Four surgical procedures were performed: cricopharyngeal myotomy alone (n = 16), excision (hand-sewn) plus myotomy (n = 51), excision (stapler) plus myotomy (n = 11), and diverticulopexy plus myotomy (n = 9). There were three surgical mortalities (3.5%) and a complication rate of 24%. Eighty patients (92%) were available for follow up. Sixty-eight patients (78%) reported excellent relief of symptoms, 10 (13%) reported improvement with occasional symptoms, and two (3%) described persistent dysphagia. No statistical difference in complication rate was found among surgical groups (P = 0.15). Myotomy alone patients had worse outcomes (P = 0.04) compared with the other surgical groups. Median follow-up was 7.5 months.
