Postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx.

OBJECTIVE: Assessment of incidence, risk factors, management, and outcome of postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. METHODS: Retrospective review of a cohort of 514 cancers of the lateral oropharynx consecutively resected. RESULTS: Incidence of postoperative hemorrhage was 3.6%. In 31.5% of cases, onset was after hospital discharge. No hemorrhages occurred after the end of the fourth postoperative week. Variables associated with increased risk of hemorrhage were advanced age (P=.004), antithrombotic treatment (P=.012), and robotic assistance (P=.009). When the source of hemorrhage could be identified, hemostasis, performed transorally in most cases, was highly effective; no patients in this subgroup showed recurrence. In spontaneously resolved hemorrhage under observation or when no active site of bleeding was found on exploration under general anesthesia, the recurrence rate was 18.1%. Overall, hemorrhage resulted in death in 2 patients. CONCLUSION: Exploration under general anesthesia in case of active bleeding and observation with discussion of arterial exploration of the ipsilateral external carotid system in patients in whom no source of bleeding can be identified are the keys to successful management of this potentially lethal complication.

Lack of adverse events after medialization laryngoplasty With the montgomery thyroplasty implant in patients with unilateral laryngeal nerve paralysis.

OBJECTIVES: We sought to document the incidence of and risk factors for adverse events after medialization laryngoplasty with Montgomery implant insertion in patients with unilateral laryngeal nerve paralysis. METHODS: We studied a retrospective series of 191 patients consecutively managed at a university teaching hospital. RESULTS: No adverse events were noted in 79.8% of the patients. Intraoperative, immediate, and late postoperative adverse events were noted in 8.3%, 8.9%, and 4.1% of the patients, respectively. The various adverse events noted were failure to insert the implant (3.6%), difficulties in stabilizing the implant (4.8%), misplacement of the implant (2.1%), dyspnea (2.7%), hematoma (4.8%), extrusion (1.6%), persistent morphological laryngeal alterations (1.6%), and keloid scars (1.1%). Tracheotomy, procedure-related death, and infection at the insertion site were not encountered. No significant statistical relationship was noted between the various adverse events encountered and the variables under analysis. CONCLUSIONS: Our data demonstrate that medialization laryngoplasty with Montgomery implant insertion in patients with unilateral laryngeal nerve paralysis from various causes is a relatively safe, reliable, and reproducible procedure with a short learning curve.

Trade-off between survival and laryngeal preservation in advanced laryngeal cancer: the otorhinolaryngology patient's perspective.

OBJECTIVES: We performed a prospective study to evaluate, from the patient's perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy. METHODS: Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables. RESULTS: We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of c re that patients agreed to trade to preserve their larynx. CONCLUSIONS: In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patient's attitude toward both laryngeal preservation and survival.

[Unilateral laryngeal paralysis in the adult patient]. / Paralysies laryngées unilatérales de l'adulte.

Based on a review of the recent medical literature, the authors document the epidemiological evolution, pathophysisology diagnosis and recent advances in treatment for adult patients with unilateral laryngeal paralysis. Speech therapy, which used to be the only therapeutic option, is nowadays complemented by efficient surgical techniques, which have modified the management of many patients.

Extended lateral pharyngotomy for selected squamous cell carcinomas of the lateral tongue base.

OBJECTIVES: In a retrospective review of an inception cohort of 26 patients with an isolated, previously untreated, moderately to well-differentiated invasive squamous cell carcinoma of the lateral tongue base, consecutively managed with an extended lateral pharyngotomy approach at a single tertiary referral care center, the authors review the key surgical points, highlight the potential technical pitfalls, and document the complications and long-term functional and oncological outcomes in terms of survival and local control. METHODS: The adjunctive measures included induction chemotherapy, ipsilateral neck dissection, and postoperative radiotherapy, used in 96.1%, 96.1%, and 38.5% of patients, respectively. All patients but 2 were followed for at least 5 years or until death (maximum, 158 months). RESULTS: The significant postoperative complications included pharyngocutaneous fistula in 3 patients (11.5%) and hemorrhage requiring reoperation, partial flap necrosis, and pneumonia from aspiration in 1 patient (3.8%) each. In univariate analysis, no significant statistical relationship was noted between the significant postoperative complications noted and the variables under analysis. Overall, successful oral alimentation was achieved in 100% of patients by the first postoperative month without gastrostomy, tracheotomy, or completion total laryngectomy. There were no intraoperative or perioperative deaths. The main causes of death were metachronous second primary tumor, intercurrent disease, and distant metastasis, resulting in 84.6%, 64%, and 46.9% 1-, 3-, and 5-year Kaplan-Meier actuarial survival estimates, respectively. Two patients (7.6%) had local recurrence, resulting in 100%, 86.7%, and 86.7% 1-, 3-, and 5-year Kaplan-Meier actuarial local control estimates, respectively. As a function of T stage, the 3- and 5-year actuarial local control estimates were 100%, 87.5%, and 90.9% in patients with tumors classified as T1, T2, and T3-T4a, respectively. CONCLUSIONS: Such results suggest that extended lateral pharyngotomy should be integrated among the various conservative treatment options available to patients with selected carcinomas of the lateral tongue base.

Immunotherapy in head and neck cancers: A new challenge for immunologists, pathologists and clinicians.

Cancer occurrence can be understood as the result of dysfunctions in immune tumoral microenvironment. Here we review the recent understandings of those microenvironment changes, regarding their causes and prognostic significance in head and neck (HN) carcinoma. We will focus on HN squamous cell cancer (SCC) and nasopharyngeal carcinomas (NPC). Their overall poor prognosis may be improved with immunotherapy in a subset of patients, as supported by current clinical trials. However, finding reliable markers of therapeutic response is crucial for patient selection, due to potential severe adverse reactions and high costs. Half of HNSCC exhibit PD-L1 expression, this expression being higher in HPV-positive tumors. In recent clinical trials, a better therapeutic response to anti-PD-1 was obtained in patients with higher PD-L1 expression. The Food and Drug Administration (FDA) approved the use of these therapeutics without stating a need for patient selection regarding PD-L1 status. Activation status, density and localization of TIL as well as PD-L2, γ-interferon, inflammatory cytokines, epithelial-mesenchymal transition phenotype and mutational burden may all be potential therapeutic response markers. In Epstein-Barr Virus (EBV)-induced nasopharyngeal non-keratinizing cancer, PD-L1 is over-expressed compared to EBV-negative tumors. A 22% response rate has been observed under anti-PD-1 treatment among PD-L1-positive NPC patients. A better understanding of immune checkpoint regulation processes may allow patients to benefit from these promising immunotherapies.

Asymmetric syntheses of 1-aryl-2,2,2-trifluoroethylamines via diastereoselective 1,2-addition of arylmetals to 2-methyl-N-(2,2,2-trifluoroethylidene)propane-2-sulfinamide.

Condensation of N-tert-butanesulfinamide (S)-1 with trifluoroacetaldehyde hydrate 2a afforded 2-methyl-N-(2,2,2-trifluoroethylidene)propane-2-sulfinamide 3. Without isolation and purification, imine 3 was added to various aryllithium reagents to give highly diastereomerically enriched adducts 5a-g. Acidic methanolysis of 5a-g provided the desired 1-aryl-2,2,2-trifluoroethylamine hydrochloride compounds 6a-g. [reaction: see text].

Survival and laryngeal preservation tradeoff in advanced laryngeal cancer: From the otorhinolaryngology patient to the managing physician.

BACKGROUND: The purpose of this study was to document the tradeoff between survival and laryngeal preservation in advanced-stage laryngeal cancer amenable to chemoradiation or total laryngectomy. METHODS: We conducted a prospective analysis based on a questionnaire completed by 209 laryngeal cancer specialists and 269 volunteers from an otorhinolaryngology clinic. RESULTS: Of the responders, 34.5% would not consider any decrease in survival to preserve their larynx. This percentage varied from 52% in otorhinolaryngologists to 27.3% in radiotherapists and 28.6% in volunteers (P < .001). Among the responders prepared to trade, the percentage of survival they were willing to trade to preserve their larynx varied from 5% to 100% (median 30%). On univariate analysis, 3 variables significantly affected this percentage: (1) the living status (single or not); (2) the existence of children; and (3) the study group (volunteers, radiation therapists, or otorhinolaryngologists) to whom the responders belong. CONCLUSION: The significant variations noted should develop modes of practice that cater to this and stimulate further research in this field.

Sternocleidomastoid myofascial flap for reconstruction after composite resection of invasive squamous cell carcinoma of the tonsillar region: technique and outcome.

OBJECTIVE: To present the surgical technique and determine the efficacy of sternocleidomastoid myofascial (SCMF) flap reconstruction after composite resection with intent to cure. STUDY DESIGN: Retrospective review of 73 consecutive patients with a previously isolated and untreated moderately to well-differentiated invasive squamous cell carcinoma of the tonsillar region and a minimum of 3 years follow-up, managed at a tertiary referral care center during the years 1970 to 2002, with an ipsilateral superiorly based SCMF flap after composite resection. METHODS: The surgical procedure is presented in detail. Potential technical pitfalls are highlighted. Survival, mortality, and morbidity are documented. Univariate analysis for potential correlation between the incidence for postoperative flap complications and various variables is also performed. RESULTS: The 1, 3, and 5 year Kaplan-Meier actuarial survival estimates were 82.2%, 64.4%, and 49.3%, respectively. Death never appeared to be related to the completion of the SCMF flap. Thirty-three (45.2%) patients had some kind of significant postoperative surgical complication, and nine (12.3%) patients had some kind of significant postoperative medical complication. The most common significant postoperative complication was partial SCMF flap necrosis and pharyngocutaneous fistula noted in 30.1% and 10.9% of patients, respectively. Complete SCMF flap necrosis was never encountered. No patient developed carotid artery rupture or died as a result of the SCMF flap, and none required additional surgery. In univariate analysis, no significant statistical relation was noted between the significant postoperative surgical complications related to the use of the SCMF flap and the variables under analysis. CONCLUSIONS: The superiorly based SCMF flap appears to be simple to perform and useful for reconstruction of defects after composite resection.

Thyroplasty type I with Montgomery implant among native French language speakers with unilateral laryngeal nerve paralysis.

OBJECTIVE: To document the long-term results achieved with the Montgomery implant in 96 French speakers with a unilateral laryngeal nerve paralysis (ULNP). STUDY DESIGN: Retrospective series, inception cohort of 96 patients. METHODS: Data regarding morbidity and functional results were obtained at regular visits to our clinic. All patients were followed for a minimum of 6 months or until death. Forty-two patients had a minimum of 12 months of follow-up. Early in the study, 36 patients were prospectively recorded under similar conditions before placement of the Montgomery implant and at 1, 3, 6, and 12 months postoperatively. RESULTS: None of the 96 patients died in the immediate postoperative period. The perioperative course was unremarkable in 94.8% of cases. Perioperative problems included failure to obtain a satisfactory phonatory result in three patients, difficulty to stabilize the implant posteriorly in one patient, and fracture of the inferior rim of the thyroid cartilage window in another patient. The primary immediate postoperative problem (within the first postoperative month) was laryngeal dyspnea, noted in four patients. According to the patient's subjective assessment, speech and voice was always improved in the immediate postoperative period. However, three patients had secondary degradation of speech and voice. Revision surgery under local anesthesia resulted in a 97.9% ultimate speech and voice success rate. According to the patient's subjective assessment, adequate swallowing in the immediate postoperative period was achieved in 94.2% of cases that had swallowing problems preoperatively. A significant statistical increase in the duration parameters (phonation time, phrase grouping, speech rate) together with a statistical significant decrease in both the jitter and shimmer values was noted when comparing the preoperative and the postoperative values at 1 month. Analysis of the evolution of the speech and voice parameters at 1, 3, 6, and 12 months postoperatively showed a significant decrease in the fundamental frequency and noise-to-harmonic ratio values but did not demonstrate any significant differences for the other speech and voice parameters. CONCLUSIONS: From the reported data, we conclude that the type I thyroplasty with Montgomery implant insertion is a safe and reproducible method to treat ULNP. Furthermore, this system achieves very good and stable phonatory results. Finally, the use of this technique and implant system appears safe in patients from various cultures with ULNP from a variety of causes and severe comorbidity. Over the past decade at our department, this procedure progressively replaced the use of the intracordal injection of autologous fat injection that was initially advocated in patients with ULNP.

Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results.

OBJECTIVES: To describe the surgical technique for transoral lateral oropharyngectomy (TLO) and its safety, postoperative management, complications, and functional outcomes. DESIGN: A 20-year retrospective case series review. Mean follow-up was 10 years. All but 10 patients were followed up until the fifth postoperative year or death. SETTING: Academic, tertiary referral center. PATIENTS: A total of 191 patients who underwent TLO for selected invasive squamous cell carcinoma of the tonsil and/or tonsillar fossa. INTERVENTIONS: Ten patients had received preoperative radiation therapy. Induction chemotherapy was used in 153 patients (80.3%). An associated neck dissection was performed in 148 patients (77.5%). Postoperative radiation therapy was administered to 52 patients (28.7%). MAIN OUTCOME MEASURES: Overall survival rate, intraoperative mortality, and perioperative mortality were determined. The need for and length of nasogastric tube feeding and tracheotomy were calculated. The incidence of significant postoperative surgical and medical complications was recorded. RESULTS: No intraoperative mortality occurred, but 5 patients (2.6%) died in the immediate postoperative period, 3 from medical complications and 2 from unknown causes. In this series, the internal carotid artery was never injured, and no cutaneous-oropharyngeal fistulas were apparent. The incidence of significant surgical complications from the oropharynx was 6.3%. Nasopharyngeal reflux and severe rhinolalia were the most common complications, occurring in 9 patients. Increasing tobacco use was statistically correlated with an increase in postoperative pneumonia from aspiration (P = .05) but no surgical complications. Seven patients (3.7%) had a temporary tracheotomy for a mean of 5 days. One hundred twelve patients (58.6%) had a nasogastric tube inserted for a mean of 6 days. No patients had a permanent gastrostomy or tracheotomy tube. The mean duration of hospitalization was 9 days. The duration of hospitalization was statistically correlated with the need for nasogastric tube placement and its duration (P<.001) or tracheotomy (P<.001). CONCLUSIONS: From a functional standpoint, the TLO is a safe surgical approach for treating selected carcinoma of the tonsillar fossa. It is a reliable technique that should be considered for treatment of appropriate squamous cell carcinoma of the tonsil.

Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence.

OBJECTIVES: To determine the incidence of local and regional failure, distant metastasis, and overall survival following transoral lateral oropharyngectomy (TLO) and to determine factors associated with local recurrence. DESIGN: Retrospective case series throughout 20 years; mean follow-up of 10 years. SETTING: Academic center. PATIENTS: A total of 166 previously untreated patients with squamous cell carcinoma of the tonsil. INTERVENTIONS: A total of 131 (81.9%) of the 166 patients received preoperative induction chemotherapy. Fifty-one patients (30.7%) underwent postoperative radiation therapy. MAIN OUTCOME MEASURES: Local and regional recurrence, distant metastasis, second primary tumors, and survival. RESULTS: The 1- and 5-year Kaplan-Meier local control estimates were 91.2% and 82.1%, respectively. The 1- and 5-year Kaplan-Meier local control estimates were 98.3% and 89.0% for T1, 88.9% and 81.7% for T2, and 78.9% and 62.7% for T3 lesions, respectively (P = .02). In univariate analysis, 7 variables were significantly associated with an increased risk of local failure: increasing T classification; positive margins of resection; poor clinical response to induction chemotherapy; tumor spread to the posterior pillar, posterior pharyngeal wall, and contralateral soft palate; and invasion of the junction between the tonsil and soft palate. In a logistic regression model, spread to the posterior pillar was the only variable statistically associated with local failure (P = .02). The 1-, 3-, and 5-year Kaplan-Meier survival estimates were 87.9%, 67.2%, and 57.7%, respectively. The Kaplan-Meier survival estimate was significantly reduced (P = .009) in patients with local failure. CONCLUSIONS: Selected tonsillar squamous cell carcinoma can be managed with TLO with local control comparable to radiotherapy. Patient selection is critical and TLO is best suited for patients with anterior T1 to T2 squamous cell carcinoma of the tonsil, without posterior anatomic spread.

Local control after supracricoid partial laryngectomy for "advanced" endolaryngeal squamous cell carcinoma classified as T3.

OBJECTIVES: To determine the incidence of local control in patients with "advanced" moderately to well-differentiated endolaryngeal invasive squamous cell carcinoma classified as T3, treated with a supracricoid partial laryngectomy; to identify any statistical relationship; and to analyze the consequences of local recurrence. DESIGN: Retrospective nonrandomized case series. SETTING: A tertiary referral care center and university teaching hospital. PATIENTS: An inception cohort of 118 patients. Tumor stage was T3 N0 M0 in 90 patients, T3 N1 M0 in 21 patients, T3 N2 M0 in 5 patients, and T3 N3 M0 in 2 patients. INTERVENTIONS: All patients underwent supracricoid partial laryngectomy. A platin-based induction chemotherapy regimen was used in 100 patients. Postoperative radiotherapy was used for 24 patients. MAIN OUTCOME MEASURES: Local recurrence, nodal recurrence, distant metastasis, and survival; univariate and multivariate analysis of local recurrence. RESULTS: Nine patients developed a local recurrence. The 1-, 3-, and 5-year actuarial local control estimates were 97.3%, 93.5%, and 91.4%, respectively. In a stepwise regression model, the presence of positive margins of resection was the only variable that statistically increased the risk of local recurrence (P =.008). Local recurrence resulted in a significant increase in nodal recurrence (P<.001) and distant metastasis (P<.001) and a significant decrease in survival (P =.03). An overall 89.8% laryngeal preservation rate and 98.3% local control rate were achieved. CONCLUSION: Supracricoid partial laryngectomies should be considered when an organ preservation strategy is discussed in patients with advanced endolaryngeal squamous cell carcinoma classified as T3.

Analysis of local recurrence in patients with selected T1-3N0M0 squamous cell carcinoma of the true vocal cord managed with a platinum-based chemotherapy-alone regimen for cure.

Based on an inception cohort of 35 patients with T1-3N0M0 squamous cell carcinoma of the true vocal cord who had a complete clinical response after a platinum-based induction chemotherapy regimen and a minimum of 3 years of follow-up, the current retrospective study documented the long-term results and consequences of local recurrence following the use of a platinum-based chemotherapy-alone regimen for cure. During the years 1985 to 1996, 231 patients with invasive squamous cell carcinoma of the true vocal cord classified as T1-3N0M0 were managed at our department with a platinum-based induction chemotherapy regimen. A complete clinical response was achieved in 77 patients. Thirty-five of the 77 patients with complete clinical response were managed at our institution with a platinum-based chemotherapy-alone regimen. The statistical analysis of data on survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier product limit method. Univariate analysis was performed for potential statistical relation between local recurrence and various variables. The 3- and 5-year actuarial survival estimates were 91.4% and 88.6%, respectively. Overall, the causes of death were intercurrent disease in 6 patients and metachronous second primary tumor in 4 patients. The 3- and 5-year actuarial local control estimate was 64.8%. No significant statistical relation could be demonstrated between the incidence for local recurrence and the variables under analysis. Salvage treatment in patients with local recurrence yielded a 100% local control rate and laryngeal preservation rate. The 3- and 5-year actuarial lymph node control estimate was 97.1%. The 3- and 5-year actuarial estimate for patients with distant metastasis was 0%. The 5- and 10-year actuarial estimates for patients with metachronous second primary tumor were 9.7% and 28.1%, respectively. Although local recurrence was noted in almost a third of patients with complete clinical response who were managed with a platinum-based chemotherapy-alone regimen, it did not appear to be detrimental, as none of the patients who had local recurrence ultimately died from their disease or lost their larynx.

[Unilateral laryngeal paralyses: epidemiological data and therapeutic progress]. / Paralysies laryngées unilatérales: données épidémiologiques et évolution thérapeutique.

OBJECTIVES: Analysis of the epidemiology and progress in treatment of unilateral laryngeal nerve paralysis. METHOD: A retrospective study in a cohort of 325 patients (1989-2001) with unilateral laryngeal nerve paralysis. RESULTS: The sex ratio was 1:2. Age varied from 16 to 98 years (mean age: 55 years). Symptoms included dysphonia in 321 patients, swallowing impairment in 126 patients and dyspnea on exertion in 3 patients. Etiologies were post-surgical (243 patients) predominantly thyroid and thoraco-mediastinal surgery, idiopathic (39 patients), tumoral (28 patients), non-surgical traumatism (8 patients) and medical causes (7 patients). The paralysis was globally related to a neoplastic disease in 50% of cases. Analysis of the evolution of the etiologies over time revealed an increase in the post surgical causes and paralysis related to a neoplastic diseases. Spontaneous recovery of unilateral laryngeal nerve paralysis occurred in 23% of patients. Surgical rehabilitation was performed in 44% of patients (thyroplasty under local anesthesia in 55 patients and intracardal injection under general anesthesia in 88 patients). The analysis of the evolution of treatment modalities showed: an increasing number of patients undergoing surgical rehabilitation, an increasing number of patients undergoing surgery under local anesthesia (thyroplasty) and an increasing number of patients refusing any surgical rehabilitation. CONCLUSION: Analysis of the data underlined the changes in the distribution of the etiologies and treatments of unilateral laryngeal nerve paralysis.

[Unilateral laryngeal nerve paralysis in the adult: Epidemiology, symptoms, physiopathology and treatment]. / Paralysies laryngées unilatérales de l'adulte : épidémiologie, symptomatologie, physiopathologie et traitement.

In France, the main causes for unilateral laryngeal nerve paralysis in the adult patient are surgery and malignant tumors. Most of unilateral laryngeal nerve paralysis following thyroid surgery will recover within the first six postoperative months. At the time of unilateral laryngeal nerve paralysis, swallowing impairment and dyspnea occur in around 30% and 5% of cases, respectively. In the face of a unilateral laryngeal nerve paralysis occurring without a history of trauma of surgery, the main paraclinical examination to perform is a computed laryngeal nerve examination analyzing the whole length of the nerve involved. Speech therapy efficiency is related to the degree of severity of the symptoms related to unilateral laryngeal nerve paralysis. In the vast majority of cases, laryngeal medialization approaches improve dysphonia and swallowing impairment related to unilateral laryngeal paralysis, but not dyspnea.

[Experimental program personalized care in patients with head and neck cancer]. / Expérimentation du parcours personnalisé des patients atteints d'un cancer des voies aéro-digestives supérieures.

OBJECTIVE: Describe the implementation and preliminary results of the "Experimental Program Personalized care" in patients with Head and Neck cancer. MATERIALS AND METHODS: After being selected a graduate nurse status, called coordination, participated in the development of forms of detection needs and concerns of patients, in collaboration with various health professionals. RESULTS: Between January 2011 and December 2012, 200 new patients with head and neck cancer were included: 62% with advanced cancer and 38% of early stage. No patient refused to participate in this experiment. At least one consultation with a psychiatrist was necessary for 82% of patients with advanced cancer. Social problems were the second axis of the needs of patients. CONCLUSION: By identifying the needs of patients and organizing their support, this evaluation optimizes not only the therapeutic care for the patient but also the management of human resources within the team.

Conventional transoral surgery for stage I-II squamous cell carcinoma of the tonsillar region.

BACKGROUND: The purpose of this study was to review the results of conventional transoral resection and neck dissection for stage I to II squamous carcinoma of the tonsillar region. METHODS: We conducted a retrospective review of 65 patients (stage I, 21 patients; stage II, 44 patients). Induction chemotherapy and postoperative radiation therapy (RT) were administered in 76.9% and 12.3%, respectively, of these cases. RESULTS: The postoperative course was uneventful in 96.9% of patients. Five-year actuarial estimates for local recurrence, nodal recurrence, distant metastasis, and survival were 0% to 7.6%, 0% to 7.8%, 0% to 7.3%, and 70.8% to 71.5% for patients with T1 to T2 carcinoma, respectively. Contralateral and retropharyngeal recurrence occurred in only 1 patient. CONCLUSION: Conventional transoral resection with ipsilateral neck dissection provides an alternative approach for patients with stage I to II squamous cell carcinoma (SCC) of the tonsillar region. A primary surgical approach spares the use of radiotherapy to eliminate late effects and to permit its use for subsequent management of metachronous head and neck second primary cancer.

Lateral pharyngotomy for selected invasive squamous cell carcinoma of the lateral oropharynx. Part II: when and why.

OBJECTIVES/HYPOTHESIS: To analyze local failure following lateral pharyngotomy for selected untreated invasive squamous cell carcinoma (SCC) of the lateral oropharynx. STUDY DESIGN: Retrospective review from a university teaching hospital. METHODS: Inception cohort of 91 patients who underwent lateral pharyngotomy for an isolated and previously untreated selected invasive carcinoma of the lateral oropharynx classified as T1 (26), T2 (47), T3 (11), and T4 (7). Induction chemotherapy, neck dissection, and postoperative radiation therapy were used in 91.2%, 94.5%, and 53.5% of patients. RESULTS: The 5-year Kaplan-Meier estimate of local failure was 16.6% for T1, 19% for T2, 38.6% for T3, and 16.7% for T4 lesions (P = .46). In a logistic regression model, only positive margins of resection statistically increased (P = .01) the risk for local failure. In patients with safe margins of resection, the 5-year Kaplan-Meier estimate of local failure was 5.6% for T1 lesions, 10.7% for T2 lesions, 23.8% for T3 lesions, and 20% for T4 lesions (P = .4). Local failure had a significant impact on increased nodal failure (P = .001) and on reduced survival (P < .0001). CONCLUSION: The lateral pharyngotomy approach should be viewed as a valuable oncologic alternative to both mandibulotomy and chemoradiation in patients with selected SCC of the lateral oropharynx.