Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma\nof the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical\nprimary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as\nthe best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly\nconfronted with considering operation among patients with significant effects of failed non-surgical\nprimary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity\nof the procedure, the functional consequences of organ mutilation, and the likelihood of success.\nAccurate selection of patients suitable for surgery is a major issue. It is essential to establish objective\ncriteria based on functional and oncologic outcomes to select the best candidates for SS. The authors\npropose first to understand preoperative prognostic factors influencing survival. Predictive modeling\nbased on preoperative information is now available to better select patients having a good chance to\nbe successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited\nlikelihood of success with salvage surgery and should be strongly considered for other treatments.\nFollowing SS, identifying patients with postoperative prognostic factors predicting high risk of\nrecurrence is essential because those patients could benefit of adjuvant treatment or be included in\nclinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent\noropharyngeal SCC patients.
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