The surgical management of head and neck sarcoma: The Newcastle experience

Abstract

Introduction: Head and neck sarcomas are rare and difficult to manage surgically. Factors that influence the prognosis include the type and grade of tumour, resection margins, the anatomical site and patient-specific parameters. We review our experience as plastic surgeons working in a bone and soft-tissue tumour multidisciplinary team (MDT) in managing these tumours surgically.

Methods: Data on all patients with sarcoma of the head or neck managed surgically from 2004 to 2015 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 sarcomas 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) and skin graft (n = 1). Twelve patients received adjuvant chemotherapy and fifteen patients received adjuvant radiotherapy. Eleven patients developed local recurrence and 10 patients developed metastasis. Twelve patients died of their disease: mean survival period was 17 months (range 8-28 months). 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.

Keywords: Free tissue transfer; Head and neck; Oncology; Reconstruction; Sarcoma.