[Primary surgery for base of tongue and tonsillar regions carcinoma: indications, surgical approaches and resections].

The oropharynx is a complex anatomical area gathering different subsites. Optimal treatment of oropharyngeal carcinoma remains still controversial. In early stages, surgery and radiation therapy are known to provide comparable oncologic results. Till recently, advanced tumors were best treated using primary radical surgery followed by postoperative radiotherapy, but new "organ sparing" approaches like concurent chemoradiotherapy seem now able to challenge primary surgery with a better functional outcome. This paper is focused on the role of primary surgery for cancer of the base of tongue and the lateral wall of the oropharynx. The surgical indications and the various surgical approaches are debated including advantages, disadvantages and tumor resections allowed by each of them respectively. Before to be considered, suitable oncologic surgery for oropharyngeal cancer should tackle 5 issues: complete resection of the tumor, adequate exposure, function preservation, minimal morbidity and simplicity of technique. During the past decade, significant advances have been observed in reconstructive surgical procedures through the use of microvascular free flaps routinely, which allows a more functional restoration of surgical defect. Current therapeutic strategy for oropharyngeal carcinoma should be settled not only following disease-free survival results but also the functional outcome of each treatment modality respectively.