Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent Head and Neck Cancer)

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BACKGROUND: Recurrent head and neck squamous cell carcinomas are an understudied subgroup, lacking high-quality evidence and thus gold standard management recommendations, resulting in major variations in practice. The aim of this project was to deliver a national multidisciplinary expert consensus on patients with recurrent head and neck squamous cell carcinoma managed by curative salvage surgery. METHODS: The Appraisal of Guidelines for Research and Evaluation II (AGREEII) protocol guided the Delphi process. Best practice statements were developed after literature review on the perioperative management and surgical salvage of major recurrent head and neck squamous cell carcinoma subsites. Members of the International Centre for Recurrent Head and Neck Cancer network and other UK-based professional stakeholder organizations were invited into an online Delphi study. Participants voted on statements over 3 rounds, with items modified in response to vote thresholds and comments. RESULTS: A total of 28 experts participated, including 11 otolaryngologists, 7 oncologists, 9 oral and maxillofacial surgeons, and 1 speech and language therapist. Consensus was achieved on 73 statements, with 29 (39.7%) achieving unanimous (threshold = 100%) and 25 (34.2%) very strongly supported (threshold > 90%) agreement. CONCLUSIONS: Salvage surgeries for recurrent head and neck squamous cell carcinoma are challenging cases that require intensive multidisciplinary input to achieve cure while balancing impact on function and quality of life. In this article, we provide a large series of statements based on UK-wide expert consensus that will guide clinicians through the complex intra- and perioperative management of patients undergoing surgical salvage.

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