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Late-Breaking Scientific Oral Presentations

Head and Neck Surgery

Session: Late-Breaking Scientific Orals: Head and Neck Surgery

Early Death in T3-T4 Head and Neck Squamous Cell Carcinoma: National Cancer Database Surgical Versus Nonsurgical Comparison

Sunday, September 29, 2024
4:00 PM – 4:06 PM EDT
Location: MBCC, 222
Disclosure(s):
Srivatsa Surya Vasudevan, MD, MS:

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

Ivan A A. Alvarez, BS:

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

Introduction: Surgeries for T3-T4 head and neck squamous cell carcinoma (HNSCC) are often complex and high-risk with potential for early death – which is not only a negative clinical outcome but also a negative quality indicator with systems-wide impact. Surgeons may be disinclined to offer surgery with increased attention paid to early death within 30 days as a quality metric. This study aims to compare surgical and non-surgical approaches in an aggressive subset of HNSCC for early death.

Methods: The National Cancer Database (NCDB) v2018 was queried for advanced T3-T4 HNSCC from 2004 to 2018. Univariate and multivariate logistic regression analysis was performed with the primary goal of comparing 30-day mortality in patients undergoing primary surgery (PS) versus radiation with or without chemotherapy (CRT).

Results: A total of 79,677 advanced head and neck cancer patients with a mean (SD) age of 62.5 (12) years, predominantly male (74%), were included in the analysis. Patients with T3-T4 HNSCC undergoing upfront surgery had an early death rate of 1.1%, compared to 4.7% for CRT (p < 0.001). This translated to significantly lower odds of early death with PS compared to CRT (OR = 0.28, 95% CI 0.22-0.37), adjusting for age, comorbidity index, stage III or IV, subsite, insurance status, and grade. Furthermore, the rate of 30-day readmission was 3.9% in patients undergoing PS.

Conclusions: This study suggests that PS is not associated with increased early death compared to non-surgical treatment for HNSCC. Furthermore, 30-day readmissions are benchmarked and considerably low for a high-risk patient population. Cancer treatment paradigms should account for observation of these findings for advanced HNSCC.

    Presenting Author(s)

  • SV

    Srivatsa Surya Vasudevan, MD, MS

    Research Associate
    Department of Otolaryngology-Head and Neck Surgery, LSU Health Shreveport, LA, USA
    Shreveport, LA, United States

    Disclosure(s):

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

    • Co-Author(s)

  • Ivan A. Alvarez, BS

    Medical Student
    LSU Health Shreveport School of Medicine, Shreveport, LA, USA
    Shreveport, Louisiana, United States

    Disclosure(s):

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

  • Cherie-Ann O. Nathan, MD

    Professor and Chair of Otolaryngology - Head & Neck Surgery
    LSU-Health Shreveport
    Shreveport, Louisiana, United States

    Disclosure information not submitted.

  • John Pang, MD

    Assistant Professor
    LSU Health Shreveport
    Shreveport, Louisiana, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • John Pang, MD

    Assistant Professor
    LSU Health Shreveport
    Shreveport, Louisiana, United States

    Disclosure information not submitted.