Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation

  • Joris B. W. Elbers
  • Lars I. Veldhuis
  • Patrick A. Bhairosing
  • Ludi E. Smeele
  • Katarzyna Jóźwiak
  • Michiel W. M. van den Brekel
  • Marcel Verheij
  • Abrahim Al-Mamgani
  • Charlotte L. ZuurEmail author
Review Article



Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria.


Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation.


16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30–45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (pheterogeneity = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days.


Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.


Head and neck squamous cell carcinoma Radiotherapy Salvage surgery Advanced stage 




Compliance with ethical standards

Conflict of interest

The authors declare that there is no competing interest.

Ethical standards

The present study is a systematic review of literature and in that sense did not involve human participants. However, all procedures we performed were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study does not fall under the scope of the Medical Research Involving Human Subjects Act (WMO), which means that no informed consent had to be obtained.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Joris B. W. Elbers
    • 1
    • 2
  • Lars I. Veldhuis
    • 2
  • Patrick A. Bhairosing
    • 3
  • Ludi E. Smeele
    • 2
    • 4
  • Katarzyna Jóźwiak
    • 5
  • Michiel W. M. van den Brekel
    • 2
    • 4
  • Marcel Verheij
    • 1
  • Abrahim Al-Mamgani
    • 1
  • Charlotte L. Zuur
    • 2
    • 4
    Email author
  1. 1.Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Department of Head and Neck Surgery and OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Scientific Information ServiceThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Department of Oral-Maxillofacial SurgeryAMCAmsterdamThe Netherlands
  5. 5.Department of Epidemiology and BiostatisticsThe Netherlands Cancer InstituteAmsterdamThe Netherlands

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