Mini-invasive lateral oropharyngectomy for T3–T4a oropharyngeal cancer

Abstract

Mandibular swing is the approach of choice for resection of advanced oropharyngeal carcinomas without bone involvement. This approach requires a mandibulotomy, which is associated with complications. A prospective outcome analysis was performed for 21 patients operated without mandibulotomy for T3-T4a oropharyngeal carcinoma. Tumour size was categorized as T3 in 14 patients (66.7 %) and as T4a (33.3 %) in 7 patients. Twelve patients were N0 (57.1 %), 2 (9.5 %) were N1, and 7 (33.3 %) were N2. Surgical margins were negative in 18 cases (85.7 %), positive in 1 (4.8 %), and close in 2 (9.5 %). Average hospital stay was 14.5 days (range 10-22). Adjuvant treatment (radiotherapy or concurrent chemoradiotherapy) was administered to all but three patients previously irradiated. In all cases radiotherapy started within 42 days of surgery. The 3-year overall survival was 85.7 %, and relapse-free survival was 71.4 %. Oropharyngectomy without mandibulotomy has the same indications as mandibular swing. It provides good access to achieve satisfactory clearance of tumours, sparing patients the morbidity associated with mandibulotomy.

The Hybrid Transoral-Pharyngotomy Approach to Oropharyngeal Carcinoma: Technique and Outcome

“…For oncologic outcomes, a local recurrence rate of 8.7% and an OS of 73%, 48%, and 38% at 1, 2, and 3 years, respectively, were reported. In a case series of 21 patients with T3 and T4a oropharynx tumors who underwent resection with a mandible-sparing lateral oropharyngectomy approach, Pelliccia et al 27 reported a fistula rate of 9.5% and locoregional recurrence rate of 14.3%. 27 At a mean follow-up of 23.7 months, Masuda et al 28 reported a 100% local control rate with a “mandible preserving pull through oropharyngectomy (MPPO)” technique on 7 patients (5 T3 and 2 T4).…”

“…In a case series of 21 patients with T3 and T4a oropharynx tumors who underwent resection with a mandible-sparing lateral oropharyngectomy approach, Pelliccia et al 27 reported a fistula rate of 9.5% and locoregional recurrence rate of 14.3%. 27 At a mean follow-up of 23.7 months, Masuda et al 28 reported a 100% local control rate with a “mandible preserving pull through oropharyngectomy (MPPO)” technique on 7 patients (5 T3 and 2 T4). In this technique, a modified radical neck dissection was first performed followed by transection of the stylomandibular ligament and detachment of the stylohyoid, styloglossus, and stylopharyngeus muscles from the styloid process to gain access to the tumor.…”

Transhyoid approach in surgical treatment of oropharyngeal carcinoma

“…Оперированы были только пациенты с начальной инвазией m. styloglossus. [8,9,11] до 100 % случаев [10]. Более того, P. Pelliccia и соавт.…”

“…Более того, P. Pelliccia и соавт. [8] обошлись вообще без лоскутов в своей серии пациентов исключительно с опухолями Т3-4, в то время как M. Roux и соавт. [10] использовали лучевой лоскут для каждого пациента, более половины из которых имели относительно небольшой (Т2) размер опухолевого поражения.…”