Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

Abstract

Background: Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods: A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results: The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.

A new landmark for lingual artery identification during transoral surgery: Anatomic‐radiologic study

“…The surgical interest in this region is mainly related to two clinical entities: OSAHS induced by BOT hypertrophy and oropharyngeal tumors. To date, transoral resection, with special reference to TORS, is among the treatment options for early oropharyngeal squamous cell carcinomas 14‐16 and other oropharyngeal malignancies such as minor salivary gland carcinomas 17,18 . In this region, vascularization is mostly provided by the lingual artery, with other minor branches arising from the tonsillar artery, ascending palatine artery, and facial artery.…”

National Analysis of Oropharyngeal Salivary Gland Malignancies Treated With Transoral Robotic Surgery

“…8,9 Schoppy et al cited a positive margin rate of 5% in a series of 20 patients undergoing transoral endoscopic resection (18 TORS, 2 transoral laser microsurgery). 9 Similarly, Villaneuva noted a 100% negative margin rate in 10 patients with T1/2 OPSGM undergoing TORS. 8 In our study, however, the overall positive margin rate was 21.0%, but this did not significantly differ by surgical approach.…”

“…8 Similarly, in a multi-institutional review of 20 patients undergoing endoscopic transoral resection, Schoppy et al cited 90% disease-free survival. 9 Because OPSGMs appear to be at an increased risk of positive margins as compared with p16+ OPSCC due to their propensity for submucosal spread and perineural invasion in some histologic types (ie, adenoid cystic carcinoma), oncologic outcomes from OPSCC cannot necessarily be applied to OPSGM. 10…”

“…7 Most literature on TORS is isolated to oropharyngeal squamous cell carcinoma (OPSCC), and data on patients with OPSGM undergoing TORS are promising but limited to small case series. 8,9 Villanueva et al reported a locoregional control rate of 80% in 10 patients with OPSGM with T1 and T2 cancer undergoing TORS. 8 Similarly, in a multi-institutional review of 20 patients undergoing endoscopic transoral resection, Schoppy et al cited 90% disease-free survival.…”

Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options

“…Transoral robotic surgery (TORS) utilizing the da Vinci surgical system has been utilized for various diseases of the head and neck, including resection of oncologic disease of the oropharynx, hypopharynx, larynx, and parapharyngeal spaces, as well as for salivary gland disorders, including removal of floor of mouth ranulas, tumors of the submandibular gland, and salivary gland stones [57,[67][68][69][70]. Robotic-assisted procedures applied specifically to submandibular stone management include the combined approach of TORS and sialendoscopy, as well as robotic sialadenectomy [57].…”