Post-operative outcomes of different surgical approaches to oropharyngeal squamous cell cancer: a case-matched study

Abstract

Objective To compare the post-operative outcomes of transoral laser microsurgery, lateral pharyngotomy and transmandibular surgery in oropharyngeal cancer management. Methods Records of 162 patients treated with transmandibular surgery, transoral laser microsurgery or lateral pharyngotomy were reviewed. The transoral laser microsurgery cohort was matched with the lateral pharyngotomy and transmandibular surgery cohorts for tumour stage, tumour subsite and human papilloma virus status, and the intra- and post-operative outcomes were compared. Results Duration of surgery and hospital stay were significantly longer for transmandibular surgery. Tracheostomy and nasogastric feeding tube rates were similar, but time to decannulation and to oral feeding were longer in the transmandibular surgery group. Transmandibular surgery more frequently required flap reconstruction and had a greater complication rate. Negative margins were fewer in the lateral pharyngotomy group than in the transoral laser microsurgery and transmandibular surgery groups. Conclusion In comparison with transmandibular surgery, transoral laser microsurgery and lateral pharyngotomy were associated with fewer complications and faster functional recovery. Lateral pharyngotomy had a higher rate of positive margins than transoral laser microsurgery, with a consequently greater need for adjuvant therapy. Many patients are nonetheless unsuitable for transoral surgery. All these factors should be considered when deciding on oropharyngeal cancer surgical treatment.

Use of a novel sealant film in head and neck surgery

“…The surgical procedures during which at least one TP was used are: 7 total laryngectomies, 1 case of salvage total laryngectomy in recurrence of laryngeal cancer after radiotherapy and 1 case of revision surgery in salivary fistula occurrence after total laryngectomy; 5 myringoplasties, 9 parotidectomies, 7 cases of oropharyngeal cancer resections treated with lateral pharyngotomy approach [6] and 2 cases of revision surgery in cochlear implants.…”

Selection of Surgical Treatment Pathways for Carcinoma of the Root of the Tongue and Discussion of Their Advantages and Disadvantages

“…The median mandibular approach can fully expose the oropharynx and can remove the tongue root and tumors involving the lateral wall of the oropharynx, soft palate, and other areas under direct vision. However, this approach causes great damage to normal tissue structure, postoperative reaction, long hospitalization time, high incidence of surgery-related complications, and scarring from the lower lip to the chin affecting the aesthetics [28]. Wang et al [29] used the median approach for surgical resection of 37 patients with malignant tumors of the tongue root, and after postoperative fixation with resorbable bone splints, there were no serious complications, such as misalignment of the occlusal relationship and bone nonunion; they concluded that this approach could effectively expose and completely resect the mass under direct vision, thus reducing the damage of the lingual artery and the hypoglossal nerve.…”