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Vol. 66. Issue 2.
Pages 74-82 (March - April 2015)
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Vol. 66. Issue 2.
Pages 74-82 (March - April 2015)
Original Article
DOI: 10.1016/j.otoeng.2014.02.017
Outcomes Following Transoral Resection of Oropharyngeal Squamous Cell Carcinoma
Resultados del tratamiento de los carcinomas epidermoides orofaríngeos mediante cirugía transoral
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Fernando López
Corresponding author
flopez_1981@yahoo.es

Corresponding author.
, José L. Llorente, César Álvarez-Marcos, Marta Morato, Carlos Suárez, Juan P. Rodrigo
Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Tables (7)
Table 1. Characteristics of the Patient Population and Their Tumors.
Table 2. T Classification According to Primary Site.
Table 3. Neck Dissection in Function of the Primary Tumor Site.
Table 4. Local Recurrence in Function of the pT Classification.
Table 5. Recurrence in Function of the Primary Tumor Site.
Table 6. Regional Recurrence in Function of the pN Classification.
Table 7. Overall Recurrence Rate by Degree of Differentiation.
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Abstract
Introduction and objectives

The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral surgery (TOS) as the primary treatment for oropharyngeal carcinoma.

Methods

We reviewed 43 previously untreated patients with oropharyngeal carcinoma, who were treated with TOS. Distribution of the primary tumor site was: tonsil (52%), soft palate (23%), base of the tongue (21%) and posterior wall (4%). Eight patients had a stage I disease, 9 had a stage II disease, 7 had a stage III disease, 16 had a stage IVA, and 3 had stage IVB disease. Eighteen patients underwent postoperative radiotherapy. Records of these patients were reviewed to obtain measures such as local and regional control, overall and disease-specific survival, and speech and swallowing function.

Results

The overall recurrence rate was 44%, and the local recurrence rate was 18%. The 5-year overall survival and disease-specific survival rates were 55% and 66%, respectively. Five-year disease-specific survival rates by site were as follows: 100%, 85%, 44%, and 30% for posterior wall, tonsil, soft palate and base of the tongue, respectively. Five-year estimates for local control were 100%, 90%, and 0% for palate, tonsil and for base of the tongue tumors, respectively. All of the patients preserved the larynx and life without tracheotomy and oral alimentation was successful without feeding tube.

Conclusion

TOS as the primary treatment approach offers a surgical alternative for treatment of the primary oropharyngeal tumor, in the era of chemoradiation therapy. This approach confers a good local control and functional outcomes.

Keywords:
Oropharyngeal carcinoma
CO2 laser
Transoral surgery
Tonsil
Base of the tongue
Minimally invasive surgical techniques
Resumen
Introducción y Objetivos

Los carcinomas de orofaringe son neoplasias agresivas habitualmente diagnosticadas en estadios avanzados. El objetivo de este estudio es exponer los resultados oncológicos y funcionales del tratamiento de estos tumores mediante resección quirúrgica transoral (RTO).

Métodos

Se realizó un estudio retrospectivo en 43 pacientes con carcinoma epidermoide de orofaringe tratados mediante RTO. En el 52% de los casos el tumor se originaba en la región amigdalina, en el 23% en el paladar blando, en el 21% en la base de la lengua y en el 4% en la pared posterior. Ocho casos se clasificaron como estadio I, 9 como estadio II, 7 como estadio III, 16 como estadio IVA y 3 como estadio IVB. Dieciocho pacientes recibieron radioterapia postoperatoria. Se revisaron las historias de estos pacientes para obtener información en cuanto a control local y regional, supervivencia total y específica de la enfermedad, y función fonatoria y deglutoria.

Resultados

La tasa global de recidivas fue del 44%, siendo la tasa de recidivas locales del 18%. La supervivencia global y específica a los 5 años fue del 55% y 66%, respectivamente. Las tasas de supervivencia específica a los 5 años según la localización tumoral fueron del 100%, 85%, 44%, y 30% para la pared posterior, amígdala, paladar blando y base de la lengua. El control local a los 5 años fue del 100%, 90%, y 0% para el paladar, amígdala y base de la lengua, respectivamente. En todos los casos se preservó la laringe, y los pacientes no requirieron traqueotomía definitiva y reanudaron la alimentación oral.

Conclusiones

La RTO es una alternativa terapéutica eficaz para el tratamiento primario de los carcinomas de orofaringe, obteniendo unos resultados oncológicos y funcionales favorables.

Palabras clave:
Carcinoma de orofaringe
LÁSER CO2
Cirugía transoral
Amígdala
Base de la lengua
Cirugía mínimamente invasiva

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