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Head and Neck Surgery

(638) Postoperative Outcomes Following Salvage Surgery with Intraoperative Radiation for Recurrent Head and Neck Cancer

Saturday, October 17, 2026

Presenting Author(s)

LM

Lauren Michelle, MD, MBA

Resident Physician
Ohio State University Hospital Program
Grove City, Ohio, United States

Co-Author(s)

LM

Lauren Michelle, MD, MBA

Resident Physician
Ohio State University Hospital Program
Grove City, Ohio, United States
Koral M. Blunt, MD

Resident Physician
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
LM

Lauren E. Miller, MD MBA

Assistant Professor Otolaryngology - Head and Neck Surgery
Ohio State University
Columbus, OH, United States
Nolan B. Seim, MD, MBA

Associate Professor Department of Otolaryngology - Head and Neck Surgery
The Ohio State University
Columbus, Ohio, United States
Stephen Y. Kang, MD, MBA, FACS

Professor and Director, Head and Neck Oncologic Surgery
The James Cancer Hospital and Solove Research Institute
Columbus, OH, United States

Senior Author(s)

James W. Rocco, MD, PhD

Professor & Chair
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Catherine T. Haring, MD

Assistant Professor
Ohio State University
Columbus, Ohio, United States

Introduction: Recurrent head and neck squamous cell carcinoma (rHNSCC) is associated with high morbidity and poor survival. Intraoperative radiation therapy (IORT) during salvage resection enables precise radiation to high-risk areas while limiting exposure to adjacent tissues. This study compares postoperative outcomes of salvage head and neck cancer surgery with free flap reconstruction (SSwFF) performed with or without IORT.

Methods: We performed a retrospective chart review of patients with rHNSCC who underwent SSwFF with or without IORT (2012-2023) after prior radiation. Outcomes included operative time, length of stay (LOS), wound healing complications, reoperation, flap failure, and readmission. Demographics, comorbidities, and associations between IORT and peri-operative outcomes were analyzed.

Results: Among 144 patients undergoing SSwFF, 33 (22.9%) underwent IORT. There were no demographic differences between groups. Operative time was longer in the IORT group (mean 716 vs 592 min, p< 0.001). The rate of wound healing complications was 31.9% (46/144), with a non-significant trend toward higher risk in IORT patients (OR 1.8, 95% CI 0.8-4.1, p=0.1), without differences in reoperation rates. Partial flap failure occurred in 5.6% (8/144) and complete flap failure in 4.2% (6/144) with a trend towards increased partial flap failure in the IORT group (OR 3.7, 95% CI 0.9-15.7), p=0.08), but no difference in complete flap failure. LOS and readmission rates did not differ.

Conclusions: Patients with rHNSCC undergoing SSwFF after prior radiation are at high risk for wound-healing complications; IORT may modestly increase this risk. IORT was not associated with increased rates of complete flap failure, reoperation, or prolonged hospitalization or readmission.