Table 1.
Prioritization Indications and Scores After 4 Rounds of Ranking
| Low‐Priority Factors | Intermediate‐Priority Factors | High‐Priority Factors | ||||||
|---|---|---|---|---|---|---|---|---|
| −4 | −3 | −2 | −1 | 0 | +1 | +2 | +3 | +4 |
| Alternative therapy available | Poor performance status (ie, ECOG PS 3, 4) | Wait time exceeded <2 wk for low‐grade histology | Wait time not exceeded but approaching for high‐grade histology | Laryngeal cancer requiring partial laryngeal surgery | Wait time exceeded by <2 wk for high‐grade histology | Wait time exceeded by ≥2 wk for high‐grade histology | ||
| Very severe comorbidity (eg noncancer survival <50% at 1 y) | Wait time not exceed but approached in 1 wk for low‐grade histology | Wait time exceeded for low‐grade histology (≥2 wk) | Hypopharyngeal cancer requiring total laryngopharyngectomy | Advanced lymph node disease (eg, N3 or macroscopic ENE) | Clinical or imaging progression (ie, advancing stage) | |||
| Low‐grade parotid malignancy | Oral cavity cancer with soft‐tissue resection | Nasal or paranasal sinus cancer requiring open anterior craniofacial surgical resection | Symptomatic disease progression while on wait list | Potential significant functional morbidity or inoperability if tumor growth | ||||
| Thyroid cancer with lymph node disease | Oral cavity cancer with bone resection | Stage III to IV disease (AJCC 8th edition) | Previous RT | Potential moderate functional or cosmetic impairment if tumor growth | ||||
| Oral cavity cancer requiring near‐total or total glossectomy | Length of surgery <4 h | Thyroid cancer with tracheal invasion | ||||||
| Oropharyngeal cancer with transoral surgery | Hospital length of stay 1‐3 d | |||||||
| Oropharyngeal cancer with mandibulotomy | No intensive care unit or step‐down unit | |||||||
| Laryngeal cancer requiring total laryngectomy | ||||||||
| Hypopharyngeal cancer with total laryngectomy and partial pharyngectomy | ||||||||
| Nasopharyngeal cancer requiring endoscopic resection | ||||||||
| Nasopharyngeal cancer requiring maxillotomy | ||||||||
| Nasal or paranasal sinus cancer requiring endoscopic resection | ||||||||
| Advanced skin cancer requiring skin resection and regional flap reconstruction | ||||||||
| Advanced skin cancer requiring free‐flap reconstruction | ||||||||
| High‐grade parotid malignancy | ||||||||
| Temporal bone malignancy | ||||||||
| Head and neck cancer with no lymph node disease | ||||||||
| Head and neck caner with limited lymph node disease | ||||||||
| Stage I to II | ||||||||
| Age <50 y | ||||||||
| Age 50‐64 y | ||||||||
| Age 65‐84 y | ||||||||
| Age ≥85 y | ||||||||
| ECOG PS 0, 1 | ||||||||
| ECOG PS 2 | ||||||||
| Patient with advanced disease and adjuvant RT is an option | ||||||||
| Length of surgery 4‐8 h | ||||||||
| Length of surgery >8 h | ||||||||
| Hospital length of stay 4‐7 d | ||||||||
| Hospital length of stay >7 d | ||||||||
| Free flap required | ||||||||
| Intensive care unit or step‐down unit required | ||||||||
| No free flap required | ||||||||
| No tracheostomy tube required | ||||||||
Abbreviations: ECOG PS, Eastern Cooperative Oncology Group performance status; ENE, extranodal extension; RT, radiotherapy.