Transoral Lateral Oropharyngectomy for Squamous Cell Carcinoma of the Tonsillar Region

Abstract

To describe the surgical technique for transoral lateral oropharyngectomy (TLO) and its safety, postoperative management, complications, and functional outcomes. Design: A 20-year retrospective case series review. Mean follow-up was 10 years. All but 10 patients were followed up until the fifth postoperative year or death. Setting: Academic, tertiary referral center. Patients: A total of 191 patients who underwent TLO for selected invasive squamous cell carcinoma of the tonsil and/or tonsillar fossa. Interventions: Ten patients had received preoperative radiation therapy. Induction chemotherapy was used in 153 patients (80.3%). An associated neck dissection was performed in 148 patients (77.5%). Postoperative radiation therapy was administered to 52 patients (28.7%). Main Outcome Measures: Overall survival rate, intraoperative mortality, and perioperative mortality were determined. The need for and length of nasogastric tube feeding and tracheotomy were calculated. The incidence of significant postoperative surgical and medical complications was recorded. Results: No intraoperative mortality occurred, but 5 patients (2.6%) died in the immediate postoperative period, 3 from medical complications and 2 from unknown causes. In this series, the internal carotid artery was never injured, and no cutaneous-oropharyngeal fistulas were apparent. The incidence of significant surgical complications from the oropharynx was 6.3%. Nasopharyngeal reflux and severe rhinolalia were the most common complications, occurring in 9 patients. Increasing tobacco use was statistically correlated with an increase in postoperative pneumonia from aspiration (P = .05) but no surgical complications. Seven patients (3.7%) had a temporary tracheotomy for a mean of 5 days. One hundred twelve patients (58.6%) had a nasogastric tube inserted for a mean of 6 days. No patients had a permanent gastrostomy or tracheotomy tube. The mean duration of hospitalization was 9 days. The duration of hospitalization was statistically correlated with the need for nasogastric tube placement and its duration (PϽ.001) or tracheotomy (PϽ.001). Conclusions: From a functional standpoint, the TLO is a safe surgical approach for treating selected carcinoma of the tonsillar fossa. It is a reliable technique that should be considered for treatment of appropriate squamous cell carcinoma of the tonsil.

Difficulties in the surgical management of head and neck cancer patient

“…Tumour size, extension and involvement of adjacent structures as well as surgeon preference dictate the surgical approach. Most tonsillar fossa tumours can be managed using a transoral approach with the aid of radiofrequency, electrocautery, CO2 LASER or robotic assistance 52,53 . Some cases may require lateral pharyngotomy approach or lip-splitting anterior mandibulotomy for mandibular swing approach.…”

Surgical Management of Oropharyngeal Squamous Cell Carcinoma

“…The technique for transoral surgical removal of tonsil tumors has been described by Weinstein et al [32] and Holsinger et al [33]. The mucosa is incised at the retromolar trigone, and dissection is carried to the pterygomandibular raphe.…”

The Role for Surgical Management of HPV-Related Oropharyngeal Carcinoma

“…Advances in minimally invasive techniques have resulted in a reevaluation of the role of surgical therapy in the management of OPSCC. Early reports by Laccourreye et al [14] demonstrated the role for transoral surgery after reporting excellent outcomes with lateral pharyngectomy for tonsillar cancer. They reported a 5-year local control rate of 89.0 % for T1 cancers and 81.7 % for T2 cancers using this technique.…”