Matthew E. Spector

There is a growing body of evidence showing that the postoperative wound healing response shares molecular machinery with tumor pathways. Within larger surgical fields such as breast or colorectal cancer, strong preclinical and clinical evidence exists demonstrating a link between postoperative wound complications and cancer recurrence. Head and neck surgery represents a unique landscape with high rates of surgical site infections (SSIs; 20–30%), driven in part by inherent wound contamination from the aerodigestive tract, in addition to prolonged operative times, malnutrition, smoking, and poor overall health. Despite this, studies addressing postoperative wound healing and head and neck cancer (HNC) recurrence remain fragmented at best, with studies demonstrating significant heterogeneity and conflicting results. A thorough understanding of the oncologic implications of wound complications in HNC is vitally important to improve patient outcomes and identify novel therapeutic strategies. This narrative review seeks to synthesize preclinical and clinical studies linking the postoperative wound environment to HNC recurrence. We also seek to highlight emerging approaches to optimize postoperative wound healing for an oncologic benefit, including the role of surgical drain fluid as a novel bioresource, alternative reconstructive hardware, the role of neoadjuvant immunotherapy, and emerging biomaterials.

Head and neck lymphedema (HNL) is a common complication of head and neck cancer (HNC) treatment. Surgery and radiation, the backbones of HNC treatment, disrupt lymphatic networks through direct injury and fibrosis, leading to accumulation of lymphatic fluid in interstitial spaces. This causes swelling of external and internal structures, leading to decreased quality of life, cosmetic distress, social withdrawal, and functional deficits such as dysphagia, dysphonia, and reduced cervical mobility. In this narrative review, we provide a broad overview of the pathophysiology, assessment, and prevention of HNL. Key surgical factors include the extent of neck dissection, including specific levels removed. Radiation compounds surgical injury through lymphatic fibrosis in a dose-dependent manner. Emerging radiation de-escalation strategies may reduce HNL, though lymphedema is rarely studied as a trial endpoint. Moreover, assessment of HNL remains challenging due to the absence of a gold standard—patient-reported outcome measures, clinician-reported scales, and instrumental tests each capture distinct components of external and internal HNL. Currently, the cornerstone of HNL treatment is conservative management with complete decongestive therapy, which shows mixed efficacy and does not address internal HNL. Surgical options including lymphovenous anastomosis and vascularized lymph node transfer show early promise but remain limited to case reports and small series. Lymphatic imaging, particularly indocyanine green lymphography, represents a promising emerging modality for guiding personalized treatment planning, though application to the head and neck remains challenging. Ultimately, current management of HNL remains largely reactive, with a noticeable lack of preventative therapies. Future research may benefit from better defining surgical options, including HNL as an endpoint in radiation de-escalation trials, and validate emerging lymphatic imaging techniques in order to improve outcomes for HNC survivors.

Head and neck lymphedema (HNL) is a common complication of head and neck cancer (HNC) treatment, with upwards of 70-90% of patients suffering from this condition. Surgery and radiation, the backbones of HNC treatment, disrupt lymphatic networks through direct injury and fibrosis, leading to accumulation of lymphatic fluid in interstitial spaces. This causes swelling of external and internal structures, leading to decreased quality of life, cosmetic distress, social withdrawal, and functional deficits such as dys-phagia, dysphonia, and reduced cervical mobility. Having a reliable assessment tool is key to diagnosing and monitoring HNL; however, few tools specific to HNL exist. Cur-rently, the cornerstone of HNL treatment is conservative management with complete decongestive therapy, which shows mixed efficacy. There is a lack of surgical options as well as prophylactic interventions. Imaging of lymphatic channels is a promising mo-dality that can help providers guide and plan personalized therapies. This paper provides a narrative review of the pathophysiology, assessment, and prevention of HNL, high-lighting future directions for improvement.

Objective: Evaluate the association between clinical characteristics and neighborhood socioeconomic disadvantage and 60‐day re‐presentation after oncologic head and neck surgery. Study Design: This retrospective cohort study involved 1,088 patients who underwent oncologic head and neck surgery from August 2012 to November 2024. Setting: Tertiary academic center. Methods: The main outcome measure was 60‐day Emergency Department (ED) visit or readmission after primary hospital discharge following surgery. Patient demographics, clinical characteristics, and neighborhood socioeconomic disadvantage, as measured by state‐level area deprivation index (ADI). Results: Predictors of re‐presentation within 60 days of discharge on univariate analysis include tumor stage 4 (OR: 1.52, 95% Cl: 1.01‐2.31, P = .044), longer primary length of stay (OR: 1.03, 95% Cl: 1.01‐1.05, P < .001), and residency in the 4th quartile state ADI (OR: 1.54, 95% Cl: 1.03‐2.31, P = .037). Multivariable logistic regression identified laryngeal cancer (OR: 1.60, 95% Cl: 1.16‐2.21, 0.004) and discharge with home health or other care facilities (2.22, 95% Cl: 1.67‐2.96, P < .001) as predictive factors. Patients from low ADI neighborhoods (Q1‐3) were more likely to be discharged home, whereas those from high ADI neighborhoods (Q4) where almost twice as likely to be discharged with home health or to care facilities than home alone (18.70% vs 10.29%, P = < .001). Conclusion: Our study demonstrates that clinical and systemic factors contribute to re‐presentation to the hospital after major oncologic head and neck surgery. Addressing these factors through targeted policies and institutional initiatives may help mitigate the morbidity and cost associated with representation.

Co-mutation plot from targeted sequencing of 73 HPV- HNSCC patient tumors