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Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with high risk human papillomavirus related squamous cell cancer

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy.

Methods

14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS).

Results

Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2–50.4).

Conclusions

This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.

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Author information

Authors and Affiliations

  1. Head and Neck unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK

    Somiah Siddiq

  2. Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK

    David Cartlidge, Sarah Stephen, Hannah Fox & David Meikle

  3. Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK

    Hans P. Sathasivam & Max Robinson

  4. Otolaryngology, Head and Neck Surgery, Newcastle upon Tyne Hospitals and Newcastle University, Newcastle upon Tyne, NE7 7DN, UK

    James O’Hara

  5. Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK

    Muhammad Shahid Iqbal & Charles G. Kelly

  6. Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Vinidh Paleri

  7. The Institute of Cancer Research, London, UK

    Vinidh Paleri

Authors
  1. Somiah Siddiq
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  2. David Cartlidge
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  3. Sarah Stephen
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  4. Hans P. Sathasivam
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Correspondence to Vinidh Paleri.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Siddiq, S., Cartlidge, D., Stephen, S. et al. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with high risk human papillomavirus related squamous cell cancer. Eur Arch Otorhinolaryngol 275, 1853–1860 (2018). https://doi.org/10.1007/s00405-018-4968-6

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  • DOI: https://doi.org/10.1007/s00405-018-4968-6

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