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Surgical site complications of isolated salvage neck dissection post-radiotherapy and post-chemoradiotherapy – A cohort analysis (1997–2017)

  • Roel Henneman
    Correspondence
    Corresponding author. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, 90203, 1006BE, Amsterdam, the Netherlands.
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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  • Linda Rouwenhorst
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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  • M Baris Karakullukcu
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands
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  • Ludwig E. Smeele
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands

    Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, the Netherlands
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  • Peter FJM. Lohuis
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands
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  • Michiel WM. van den Brekel
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands

    Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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  • Olga Hamming-Vrieze
    Affiliations
    Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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  • Katarzyna Jóźwiak
    Affiliations
    Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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  • Alfons JM. Balm
    Affiliations
    Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, the Netherlands
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Published:December 26, 2022DOI:https://doi.org/10.1016/j.ejso.2022.12.010

      Abstract

      Introduction

      This study aims to quantify surgical site complications (SSC) after isolated salvage neck dissection (ND) compared with primary ND.

      Patients and methods

      Between 1997 and 2017 in the Netherlands Cancer Institute - Antoni van Leeuwenhoek, a total of 323 isolated NDs were performed in 308 patients: primary ND (n = 144), post-radiotherapy (RT) ND (n = 53) and post-chemoradiotherapy (CRT) ND (n = 126). Patient, tumor and therapy characteristics were recorded. SSCs were scored according to the Clavien-Dindo Classification (CDC).

      Results

      101 NDs (31%) were complicated by at least one SSC. In total, 189 different SSCs occurred. Translated to CDC, 45 complications were grade 2, 25 grade 3a and 31 grade 3b. No significant difference in occurrence of SSC (CDC >1) was found between all groups. However, post-CRT, selective (SND) and modified radical ND and radical ND (MRND/RND) (p = 0.005), resection of sternocleidomastoid muscle (SCM) (p = 0.039) and duration of super selective ND surgery (p = 0.048) were significantly associated with more SSC. SCM muscle removal was associated with more surgical site infection (p = 0.045) and necrosis (p = 0.036). From week 10 post-RT/CRT, no difference in complication frequency with primary ND was seen.

      Conclusion

      Post-CRT SND, MRND/RND and SCM muscle resection were associated with an increased incidence of SSCs. If oncologically possible, limit the extent of ND and when an MRND is inevitable, preserve the SCM muscle for optimal prevention of SSC. Concerning SSC, optimal timing of salvage ND is minimal 10 weeks after RT/CRT.

      Keywords

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