Salvage Surgery in Recurrent Oral and Oropharyngeal Cancer

Tuesday, October 14, 2025

8:00 AM - 9:00 AM EDT

Location: 103

PROGRAM DESCRIPTION: Moderator: Claudio Roberto Cernea
Principles of salvage surgery in head and neck surgery, Fernando Walder
Prognostic factors in salvage surgery, Luiz Paulo Kowalski
Salvage surgery in recurrent oral cancer, Pankaj Chatuverdy
Salvage Robotic Surgery in Recurrent Oropharyngeal cancer, Fernando L. Dias
Case discussion: Roberto A. Lima and Rogério Dedivitis

Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival.
The assessment of the exact tumor extension of recurrent laryngeal carcinomas may be difficult because of the residual inflammatory or the functional changes associated with radiation therapy. Furthermore, tumor recurrence may be localized submucosally—invisible during endoscopy—or may consist of microscopic tumor foci, undetectable by imaging studies, and not rarely, difficult to detect even in an advanced pathologic tumor stage.
The most obvious differences in growth pattern between the recurrent and primary glottic carcinoma were as follows: the multifocality of tumor nests in recurrent tumors versus the concentrical growth pattern in primary carcinomas; the high percentage of undifferentiated dissociated tumors cells in the recurrent carcinomas; the high percentage of perineural infiltration in recurrent tumors; and the high percentage of contralateral tumor spread.
Salvage surgery includes open, transoral, and robot-assisted techniques. When feasible, salvage surgery has been shown in retrospective studies to improve local control, disease-free, and overall survival (DFS and OS) in patients treated with salvage surgery compared to patients either not eligible for salvage surgery or treated non-surgically.

OUTCOME OBJECTIVE 1: To understand the pattern of tumor spread in Head and Neck Squamous Carcinomas and to compare the growth pattern of prT3-4 (recurrent) carcinomas with the growth pattern of “de novo”pT3-4.

OUTCOME OBJECTIVE 2: Several factors modulate the oncologic results of Salvage Surgery. Thus, we aim to review the already identified prognostic factors as well as its role when selecting patients for Salvage Surgery.

OUTCOME OBJECTIVE 3: Discuss patient selection criteria and factors influencing the choice of available tools and technics for salvage surgeries, such as Transoral Robotic Surgery, Free-flap Surgery, use of fluorescent-guide surgeries, and management of the neck.

BACKGROUND STATEMENT:

Comprehensive Otolaryngology Track Statement :

Moderator(s)

Claudio R. Cernea, MD, PhD

Professor of Surgery
Hospital das Clínicas, University of São Paulo School of Medicine
São Paulo, Sao Paulo, Brazil

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Panelist(s)

Rogerio A. Dedivitis, MD, PhD

Assistant Professor
University of Sao Paulo School of Medicine
Santos, Sao Paulo, Brazil

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
PC

Pankaj Chaturvedi, MD

Director
Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial centre
Navi Mumbai, Maharashtra, India

Disclosure information not submitted.
Fernando L. Dias, MD, PhD, FACS

Chairman & Chief
Catholic University of Rio de Janeiro; Brazilian National Cancer Institute
Rio de Janeiro, Rio de Janeiro, Brazil

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Luiz P. Kowalski, MD

Professor and Chairman
University of Sao Paulo Medical School and A C Camargo Cancer Center
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
Fernando Walder, MD

Full Professor Assistant ENT and Head and Neck Department President of Brazilian Head and Neck Society
University Federal of Sao Paulo
Sao Paulo, Sao Paulo, Brazil

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Roberto A. Lima, MD, PhD

Director and Attending Surgeon Head and Neck Service
Brazilian National Cancer Institute/INCA
Rio de Janeiro, Rio de Janeiro, Brazil

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.