Ten‐Year Efficacy of Transoral Surgery for Squamous Carcinoma of the Lateral Oropharynx

Abstract

ObjectivesTo document the 10‐year results of transoral mandibular preservation surgery for patients with T1‐2 squamous cell carcinoma (SCC) arising from the lateral oropharynx.MethodsThis was a retrospective 30‐year review using STROBE guidelines at an academic, tertiary referral center. A total of 294 patients with T1‐2 SCC of the lateral oropharynx were reviewed. Only 19% of patients were never‐smokers, suggesting a predominantly HPV‐negative population. All patients had transoral mandibular preservation surgery. Follow‐up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and postoperative radiation therapy (31.6%) Local control, survival, and functional endpoints, as well as the consequences of local recurrence, were analyzed.ResultsThe 10‐year local disease control was 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% local control rate. The overall 10‐year survival was 50%. Mortality was related to metachronous second primary cancer (MSPC) (29.2%), medical comorbidities (25.7%), uncontrolled local recurrence (10%), and complications following transoral resection (4.2%). In multivariate analysis, the development of an MSPC significantly increased (p < 0.005) the risk of death. Overall, 95.2% of patients achieved mandibular preservation. However, gastrostomy and tracheostomy dependence occurred in 1% and 0.3% of cases, respectively.ConclusionsFor a patient population with a significant percentage of tobacco‐associated oropharyngeal cancer (OPC), transoral surgery was associated with long‐term minimal postoperative complications and a high rate of local control. MSPC was the main cause of death during the first 10 postoperative years. Such long‐term figures support transoral surgery as an effective first‐line treatment for early‐stage predominantly tobacco‐related OPC.Level of Evidence4 Laryngoscope, 2024