Somiah Siddiq1, David Cartlidge2, Sarah Stephen2, Hans P Sathasivam3, Hannah Fox2, James O'Hara4, David Meikle2, Muhammad Shahid Iqbal5, Charles G Kelly5, Max Robinson3, Vinidh Paleri6,7. 1. Head and Neck unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK. 2. Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK. 3. Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. 4. Otolaryngology, Head and Neck Surgery, Newcastle upon Tyne Hospitals and Newcastle University, Newcastle upon Tyne, NE7 7DN, UK. 5. Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK. 6. Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK. vinidh.paleri@rmh.nhs.uk. 7. The Institute of Cancer Research, London, UK. vinidh.paleri@rmh.nhs.uk.
Abstract
PURPOSE: Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. METHODS: 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). RESULTS: Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4). CONCLUSIONS: This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.
PURPOSE: Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. METHODS: 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). RESULTS: Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4). CONCLUSIONS: This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.
Entities:
Keywords:
Lateral oropharyngectomy; Oropharyngeal cancer; Step serial sectioning; TORS; Tonsillectomy
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