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Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with recurrent oropharyngeal cancer often require extensive salvage surgery. For patients with clinically N0 necks, the indication for concurrent neck dissection remains unclear. This study aimed to determine predictors, prevalence, and distribution of nodal disease in patients treated with salvage oropharyngectomy.

Methods

In a case series with data collection at a single tertiary academic National Cancer Institute (NCI)-designated comprehensive cancer center, this study analyzed patients treated with prior radiation or chemoradiation who had persistent, recurrent, or second primary squamous cell carcinoma of the oropharynx requiring oropharyngeal resection between 1998 and 2017 (n = 95). Clinical and oncologic characteristics and treatment outcomes were collected, and statistical analyses were performed.

Results

The overall rate of nodal positivity was 21% (24/95), and the rate of occult nodal disease was 6% (4/65). Ipsilateral and contralateral level 2 were the most common areas harboring positive nodes. Bivariate analysis showed female sex (p = 0.01), initial overall stage (p = 0.02), and N status (p = 0.03), as well as recurrent overall and T stage (p = 0.05) to be predictors of nodal disease. In the multivariate analysis, recurrent T stage continued to be significantly predictive of pathologic nodal disease. Both computed tomography (CT) and positron emission tomography–CT were moderately accurate in predicting nodal disease in the salvage setting (area under the curve, 0.79 and 0.80, respectively).

Conclusion

Occult nodal disease is observed in few patients undergoing salvage oropharyngeal resection. This study identified factors predictive of nodal disease in patients undergoing salvage oropharyngectomy and appropriate diagnostic tests in this setting.

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Author notes

  1. AJ Rosko and ME Spector are contributed equally to this work.

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA

    M. E. Heft Neal MD, J. Brennan MD, J. C. Brenner PhD, A. G. Shuman MD, S. B. Chinn MD, C. L. Stucken MD, K. M. Malloy MD, J. S. Moyer MD, K. A. Casper MD, S. A. McLean MD, M. E. P. Prince MD, C. R. Bradford MD, G. T. Wolf MD, A. J. Rosko MD & M. E. Spector MD

  2. Head and Neck Surgical Oncology and Reconstructive Microsurgery, Department of Otolaryngology, Department of Surgical Oncology, University of Toronto, Toronto, ON, USA

    D. B. Chepeha MD

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  1. M. E. Heft Neal MD
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Correspondence to M. E. Spector MD.

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Heft Neal, M.E., Brennan, J., Brenner, J.C. et al. Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy. Ann Surg Oncol 27, 451–457 (2020). https://doi.org/10.1245/s10434-019-07841-7

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  • DOI: https://doi.org/10.1245/s10434-019-07841-7

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