Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma

Abstract

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.

Transoral laser microsurgery for oral squamous cell carcinoma: Oncologic outcomes and prognostic factors

“…Compared to a previously reported all-inclusive, T1 to T4, TLM series by Eckel et al 10 ( n = 64), the current study had comparable DSS estimates for stages I to III, and slightly better outcomes for stage IV lesions (31% vs 21%, 10 respectively). Unlike our study, all neck dissections in the Eckel et al 10 series were staged.…”

“…Higher margin positivity has been documented in TLM studies on oral cancer in the absence of frozen sections. 10 Eckel et al, 10 reported a margin positivity rate of 37%, although residual tumor could be found in only 15% of the re-resections. This was attributed to nonavailability of frozen sections during the surgery.…”

“…9 TLM for higher T classifications is documented in a smaller cohort ( n = 64), all but with staged neck dissection(s). 10 The latter study reported a recurrence rate of 36%, with 5-year tumor-related survival estimates of 81% for stages I to II, 73% for stage III, and 21% for stage IV tumors. Non-TLM surgical studies for all-stage OSCC report 5-year disease-related survival estimates from 42% to 76%, and recurrence rates of 15% to 30%.…”

Postoperative Adjuvant Therapy after Transoral Robotic Resection for Oropharyngeal Carcinomas: Rationale and Current Treatment Approach

“…There are several advantages to this approach weighed against the risks of protracting the time to start PORT as described above. We adopted the staged approach to the neck dissection to not only reduce the risk of fistula and surgical complications [28] but also to provide us with pathologic information at the primary site. This pathologic evaluation of the primary tumor can significantly influence the decision and recommendations for both neck dissection and/or adjuvant therapy to the ipsilateral and contralateral neck ( table 2 ).…”

Current Status of Endoscopic Laser Surgery in Head and Neck Surgical Oncology

“…Moreover, successful treatment of stage II-IV lesions of the vocal folds, the supraglottic larynx, the oral cavity, and oro-and hypopharynx have recently been reported in the literature [14][15][16][17]. While the data presented in these studies indicate that TLS leads to oncological results that are comparable with more conventional treatment modalities in selected groups of patients, the potential role of laser surgery for larger series of unselected cases has not been settled to date.…”