Transoral robotic surgery for tonsillar cancer: Addressing the contralateral tonsil

Abstract

All patients undergoing primary TORS for tonsillar cancers should also undergo contralateral tonsillectomy to optimize oncologic outcomes with no increase in morbidity.

Should the Contralateral Tonsil Be Removed in Cases of HPV‐Positive Squamous Cell Carcinoma of the Tonsil?

“…The only statistically significant difference was an increased operative blood loss of 11.5 cc more in the patients who underwent bilateral surgery ( P = .001). Of note, contrary to the findings from Roeser et al and Theodoraki et al, Dziegielewski et al found that the contralateral tonsil exhibited metabolic activity at physiological levels on PET‐CT in their three patients. These authors caution that contralateral TSCC may be more indolent and easily missed on imaging and thus recommend that all patients who are undergoing primary TORS for TSCC also undergo contralateral tonsillectomy to obtain definitive tissue diagnosis.…”

“…Dziegielewski et al performed a retrospective review specifically in patients who underwent TORS for known tonsillar cancer. Of the 79 consecutive patients with HPV+ TSCC who underwent primary TORS radical tonsillectomy, 30 patients also underwent contralateral tonsillectomy.…”

“…Furthermore, preoperative clinical exam findings and imaging studies including PET‐CT should not be used to exclude the possibility of SBTC. Although there are reports of significant complications resulting from bilateral radical surgery, performing a routine contralateral tonsillectomy does not appear to increase rates of morbidity or complications, and the resulting symmetric palatal arch could potentially improve oncologic surveillance and detection of recurrence. Furthermore, identifying a contralateral TSCC can dramatically alter treatment and prognosis.…”

“…The palatine tonsils are the most commonly involved anatomical subsite, followed by the base of tongue and then the soft palate . Secondary primary malignancy (SPM) is a well‐established phenomenon among patients with head and neck SCC and can present in up to 36% of patients within 20 years of their original diagnosis . Furthermore, synchronous tumors are defined as those that occur simultaneously with the index cancer; these tumors are present in approximately 4% of cases …”

In Reference to Should the Contralateral Tonsil Be Removed in Cases of HPV‐Positive Squamous Cell Carcinoma of the Tonsil?

“…However, this is based on only 30 patients from a single study. 6 Our experience suggests that patients with a bilateral tonsillectomy trend toward increased postoperative pain, dysphagia, bleeding, and readmissions. In our series, there was a trend toward patients who underwent contralateral tonsillectomy being more likely to have a postoperative bleed.…”