Long-Term Efficacy of Transoral Mandibular Preservation Therapy for T1-2 SCC of Lateral Oropharynx Confirmed

by Linda Kossoff •

CLINICAL QUESTION

What does retrospective data reveal about the 10-year efficacy of transoral mandibular preservation surgery for patients with T1-2 squamous cell carcinoma (SCC) arising from the lateral oropharynx?

BOTTOM LINE

For a patient population with a significant percentage of tobacco-associated oropharyngeal cancer, transoral surgery was associated with minimal long-term post-operative complications and a high rate of local control.

BACKGROUND: The use of transoral resection in patients with lateral oropharyngeal SCC classified as T1-2 has challenged the primary role of radiation and chemoradiation therapy for this disease; however, 10-year results in a large series of patients with T1-2 SCCs of the lateral oropharynx are not well studied for this frontline surgical approach.

STUDY DESIGN: Retrospective study

SETTING: Université Paris Cité, Service d’Oto-rhino-laryngologie et de Chirurgie Cervico–Faciale, HEGP, AP-HP, Paris, France.

SYNOPSIS: Researchers reviewed 294 patients (227 males; mean age 58 years) with previously untreated T1-2 SCC of the lateral oropharynx who received transoral mandibular preservation surgery between 1982 and 2012. Nineteen percent were never-smokers, suggesting a predominantly HPV-negative population. The SCC distribution among patients was tonsil (n=164), anterior tonsillar pillar (n=95), posterior tonsillar pillar (n=22), and infra tonsillar region (n=12). Follow-up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and post-operative radiation therapy (31.6%). The researchers analyzed local control, survival, functional endpoints, and consequences of local recurrence. Results revealed a 10-year local disease control rate of 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% control rate. Margin status significantly increased the risk for local recurrence. The 10-year survival was 50%, with mortality related to metachronous second primary cancer (29.2%), medical comorbidities (25.7%), uncontrolled recurrence (10%), and complications following resection (4.2%). Overall, 95.2% of patients achieved mandibular preservation. Authors note that despite some encouraging results, local recurrence still proved devastating, and they emphasize the need for surgeons to resect and not hesitate to check margins using frozen sections. Study limitations included potential selection or recall bias.

CITATION: Laccourreye O, et al. Ten-year efficacy of transoral surgery for squamous carcinoma of the lateral oropharynx. Laryngoscope. 2024;134(11):4564-4572. doi: 10.1002/lary.31574.