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

Publication date: Available online 5 October 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): R.W.F. Breakey, I.B. Anderson, T.P. Crowley, R.H. Milner, M. Ragbir
IntroductionSarcomas 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.MethodsData on all patients with sarcoma of the head or neck managed surgically from 2004-2014 was reviewed. Demographics, surgical details and outcomes were analysed.ResultsForty-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).ConclusionHead 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.



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