Head and Neck Reconstruction after Salvage Surgery in the Immunotherapy Era: An Evidence-Informed, Risk-Stratified Surgical Framework

Uppaluri R, Haddad RI, Tao Y, Le Tourneau C, Lee NY, Westra W, et al. Neoadjuvant and adjuvant pembrolizumab in locally advanced head and neck cancer. N Engl J Med. 2025;393(1):37–50.

Article  CAS  PubMed  Google Scholar 

Burtness B, Harrington KJ, Greil R, Soulières D, Tahara M, de Castro G Jr, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019;394(10212):1915–28.

Article  CAS  PubMed  Google Scholar 

Ferris RL, Blumenschein G Jr, Fayette J, Guigay J, Colevas AD, Licitra L, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med. 2016;375(19):1856–67.

Article  PubMed  PubMed Central  Google Scholar 

De Virgilio A, Costantino A, Festa BM, Russo E, Malvezzi L, Pellini R, et al. Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: a systematic review and network meta-analysis. Eur Arch Otorhinolaryngol. 2022;279(12):5839–49.

Article  PubMed  Google Scholar 

Cabrera CI, Joseph Jones A, Philleo Parker N, Emily Lynn Blevins A, Weidenbecher MS. Pectoralis major onlay vs interpositional reconstruction fistulation after salvage total laryngectomy: systematic review and Meta-analysis. Otolaryngol Head Neck Surg. 2021;164(5):972–83.

Article  PubMed  Google Scholar 

Williamson A, Shah F, Benaran I, Paleri V. Vascularized tissue to reduce fistula after salvage total laryngectomy: A network Meta-analysis. Laryngoscope. 2024;134(7):2991–3002.

Article  PubMed  Google Scholar 

Baek CH, Park W, Choi N, Gu S, Sohn I, Chung MK. Free flap outcome of salvage surgery compared to primary surgery for head and neck defects: A propensity score analysis. Oral Oncol. 2016;62:85–9.

Article  PubMed  Google Scholar 

Correia C, Wang W, Vincent AG, Chan D, Ducic Y. Regional salvage flap options in head and neck reconstruction. Semin Plast Surg. 2020;34(4):293–8.

Article  PubMed  PubMed Central  Google Scholar 

Chang BA, Asarkar AA, Horwich PM, Nathan CAO, Hayden RE. Regional pedicled flap salvage options for large head and neck defects: the old, the new, and the forgotten. Laryngoscope Investig Otolaryngol. 2023;8(1):63–75.

Article  PubMed  Google Scholar 

Noothanapati NR, Akali NR, Buggaveeti R, Balasubramanian D, Mathew J, Iyer S, et al. Reconstruction in salvage surgery for head and neck cancers. Craniomaxillofacial Trauma Reconstr. 2023;16(3):211–21.

Article  Google Scholar 

Kameni LE, Januszyk M, Berry CE, Downer MA, Parker JB, Morgan AG, et al. A review of Radiation-Induced vascular injury and clinical impact. Ann Plast Surg. 2024;92(2):181–5.

Article  CAS  PubMed  Google Scholar 

King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of Radiation-Induced dysphagia in head and neck cancer. Dysphagia. 2016;31(3):339–51.

Article  PubMed  PubMed Central  Google Scholar 

Muehlebach ME, Pradeep S, Chen X, Arnold L, Arthur AE, Gan GN, et al. Radiation-Induced fibrosis (RIF) in head and neck squamous cell carcinoma (HNSCC): A review. Cells. 2025;14(24):1969.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Ribas A, Wolchok JD. Cancer immunotherapy using checkpoint Blockade. Science. 2018;359(6382):1350–5.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Miller H, Bush K, Delancy M, Leo ND, Joshi H, Saracco B, et al. Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: an updated systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75(2):743–52.

Article  PubMed  Google Scholar 

Konuthula N, Do OA, Gobillot T, Rodriguez CP, Futran ND, Houlton J, et al. Oncologic outcomes of salvage surgery and immune checkpoint inhibitor therapy in recurrent head and neck squamous cell carcinoma: A single-institution retrospective study. Head Neck. 2022;44(11):2465–72.

Article  PubMed  Google Scholar 

Hanna GJ, O’Neill A, Shin KY, Wong K, Jo VY, Quinn CT, et al. Neoadjuvant and adjuvant nivolumab and lirilumab in patients with Recurrent, resectable squamous cell carcinoma of the head and neck. Clin Cancer Res. 2022;28(3):468–78.

Article  CAS  PubMed  Google Scholar 

Leddon JL, Gulati S, Haque S, Allen C, Palackdharry S, Mathews M, et al. Phase II trial of adjuvant nivolumab following salvage resection in patients with recurrent squamous cell carcinoma of the head and neck. Clin Cancer Res. 2022;28(16):3464–72.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Tsushima N, Shinozaki T, Fujisawa T, Tomioka T, Okano W, Ikeda M, et al. Salvage reconstructive surgery during nivolumab therapy for a patient with hypopharyngeal cancer. Clin Med Insights Case Rep. 2020;13:1179547620908854.

Article  PubMed  PubMed Central  Google Scholar 

Jaxa-Kwiatkowski A, Jaxa-Kwiatkowski M, Jaxa-Kwiatkowska K, Gerber H, Kubiak M, Łysenko L. Perioperative nutritional and metabolic factors affecting surgical outcomes in head and neck cancer free flap reconstruction: A comprehensive review. J Clin Med. 2025;14(11):3679.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Kaki PC, Patel AM, Brant JA, Cannady SB, Rajasekaran K, Brody RM, et al. Geriatric nutritional risk index and postoperative outcomes following head and neck cancer surgery. Head Neck. 2025;47(5):1421–32.

Article  PubMed  Google Scholar 

Michot JM, Bigenwald C, Champiat S, Collins M, Carbonnel F, Postel-Vinay S, et al. Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer. 2016;54:139–48.

Article  CAS  PubMed  Google Scholar 

Yamamoto T, Shinozaki T, Nishiya Y, Okano W, Tomioka T, Matsuura K, et al. Early enteral nutrition and mobilization following head and neck surgery with free flap reconstruction. Jpn J Clin Oncol. 2024;54(7):770–7.

Article  PubMed  Google Scholar 

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