AHNS
Conall Fitzgerald, MD
Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
NEW YORK, New York
Overall rate of PCF was 23% (n = 127). The median time to development of PCF was 2.9 weeks (interquartile range [IQR], 0.6-3.5 weeks). Surgical management of PCF was required in 43% (n=54) while the remaining 57% (n=73) required wound care alone. Rate of PCF varied by primary treatment modality [primary radiation, 20% (n=76); primary chemoradiation, 27% (n=40)]. Rate of PCF also varied with use of vascularized tissue in pharyngeal closure [free/regional flap onlay/inlay, 18% (n=25); no vascularized tissue/primary closure, 24% (n=98)]. Significant association between PCF following TL and advanced clinical local disease (T3 or T4), positive surgical margin, close surgical margin ( <5mm), lymphovascular invasion and pre-treatment tracheostomy were identified on univariable analysis. There was no significant association on univariable analysis between PCF and treatment with chemoradiation (p=0.14) or use of vascularized tissue in reconstruction (p=0.12). Positive surgical margin (HR, 1.91; 95% CI, 1.11 to 3.29) was the only significant association on multivariable analysis.
Conclusion: This international multicenter retrospective cohort study highlights increased risk of PCF following salvage TL in patients with positive surgical margin. To our knowledge, this is the largest published dataset on PCF following TL, providing benchmark data across several high-volume academic head and neck oncology centers.