The Surgical Management of Head and Neck Sarcoma: The Newcastle Experience

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 70; no. 1; pp. 78 - 84
• Main Authors: Breakey, R.W.F, Anderson, I.B, Crowley, T.P., Mr, Milner, R.H, Ragbir, M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Free tissue transfer; Head and neck; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Infant; Male; Middle Aged; Oncology; Plastic Surgery; Reconstruction; Reconstructive Surgical Procedures; Retrospective Studies; Sarcoma; Sarcoma - mortality; Sarcoma - pathology; Sarcoma - surgery; Surgical Flaps; Survival Rate; Treatment Outcome; United Kingdom; Young Adult; head and neck; reconstruction; Sarcoma; oncology; free tissue transfer; Reconstruction; Head and neck; Oncology; Free tissue transfer
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2016.09.026

Abstract Introduction Sarcomas occurring in the head and neck are rare and difficult to manage surgically. Factors which influence prognosis include; type and grade of tumour, resection margins, anatomical site and patient specific factors. We review our experience of managing these tumours surgically as plastic surgeons within a bone and soft tissue tumour multi disciplinary team. Methods Data on all patients with sarcoma of the head or neck managed surgically from 2004-2014 was reviewed. Demographics, surgical details and outcomes were analysed. Results Forty-nine patients underwent surgery for sarcoma of the head or neck. The mean age at presentation was 53.1 years (range 0.5-92). Histological diagnosis was varied. Leiomyosarcoma (n=6), angiosarcoma (n=9), synovial sarcoma (n=4), sarcoma of no specific type (n=5) and rhabdomyosarcoma (n=5) were the most frequently seen tumours. All were treated by wide excision. Excision margins were histologically complete in the vast majority (n=43). Reconstruction was undertaken as follows: direct closure (n=12), local flap +- skin graft (n=12), free tissue transfer (n=21), pedicled flap +- skin graft (n=3), skin graft (n=1). Twelve patients received adjuvant chemotherapy and fifteen patients received adjuvant radiotherapy. Eleven patients developed local recurrence and ten patients developed metastasis. Twelve patients died of their disease; mean survival 17 months (range 8-28). The mean duration of follow up was 78 months (range 18-137 months). Estimated 5-year disease specific survival for this cohort was 72% and overall estimated survival was 61% (Kaplan-Meier equation). Conclusion Head and neck sarcomas are rare and challenging to manage. Successful outcomes can be achieved by early, aggressive resection and appropriate reconstruction within the specialist MDT setting.