ENTtoday

Literature Review: A Roundup of Important Recent Studies

TORS Alone Effective for Select Cases of Oropharyngeal Cancer

Is transoral robotic surgery (TORS) adequate treatment for oropharyngeal squamous cell cancer (OPSCC)?

Background: OPSCC is increasingly treated non-surgically with radiation therapy or chemoradiation, due to morbidity of primary site resection and a high incidence of nodal metastases. TORS has been proposed as an alternative approach to surgical resection because it is associated with lower morbidity than transmandibular or transcervical approaches. It is unclear whether TORS with staged neck dissection is adequate treatment in patients without high-risk pathologic features.

Study design: Retrospective review.

Setting: University of Pennsylvania Medical Center tertiary care hospital.

Synopsis: Thirty previously untreated patients with OPSCC underwent TORS for primary site resection followed by staged neck dissection. Human papilloma virus (HPV) status was not reported for this cohort. The majority of patients had T1 (30 percent) or T2 (53 percent) tumors and N0 (50 percent) or N1 (33 percent) nodal stage. Patients with N2c and N3 disease and those with extracapsular spread on pathologic analysis of nodal specimens were excluded from analysis. The mean follow-up was 18 months. One patient had a positive margin successfully treated with re-resection. Ten cases had pathologic nodal disease; the number of lymph nodes involved was not reported. Two patients had perineural invasion on histopathology. One patient with a T2 initial lesion developed local recurrence less than four months after TORS and was treated with chemoradiation. Three patients developed regional recurrence, two of whom presented with N2b disease and one with initial N0 disease. Two recurrences occurred in the ipsilateral dissected neck and one in the contralateral neck, and all were subsequently treated with chemoradiation. The overall survival rate was 100 percent. At last follow-up, no patient required a feeding tube.

Bottom line: TORS combined with neck dissection may be adequate treatment for a select group of OPSCC patients with limited primary site and nodal disease when clear margins can be accomplished and extracapsular spread is not present in lymph nodes. A limitation of this study is lack of information regarding the number of lymph nodes involved on pathologic analysis and HPV status. A high proportion of HPV-positive oropharyngeal tumors may explain the favorable outcomes observed.