Skip to main content
Log in

Primary Surgical Management of Oropharyngeal Squamous Cell Carcinoma

  • HPV in Head and Neck Cancer (J. Rocco, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) has been advanced by the development of transoral surgical approaches. Transoral robotic surgery and transoral laser microsurgery are two approaches that allow minimally invasive surgical treatment of OPSCC. In this article, we review the most recent literature regarding the use of TORS and TLM in the surgical management of OPSCC, with a focus on indications, oncologic, and functional outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Weinstein GS, O’Malley BW Jr, Rinaldo A, Silver CE, Werner JA, Ferlito A. Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer. Eur Arch Otorhinolaryngol. 2014. doi:10.1007/s00405-014-3331-9.

  2. •• Kelly K, Johnson-Obaseki S, Lumingu J, Corsten M. Oncologic, functional and surgical outcomes of primary transoral robotic surgery for early squamous cell cancer of the oropharynx: a systematic review. Oral Oncol. 2014;50:696–703. These authors performed a systematic review of the literature and report oncologic, functional, and surgical outcomes in patients with T1T2 OPSCC treated with TORS..

  3. •• de Almeida JR, Byrd JK, Wu R, Stucken CL, Duvvuri U, Goldstein DP, Miles BA, Teng MS, Gupta V, Genden EM. A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope. 2014;124:2096–102. These authors performed a systematic review of the literature comparing TORS to intensity-modulated radiation therapy in the treatment of T1T2 OPSCC.

  4. Lorincz BB, Mockelmann N, Busch CJ, Knecht R. Functional outcomes, feasibility, and safety of resection of transoral robotic surgery: single-institution series of 35 consecutive cases of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck. 2014. doi:10.1002/hed.23809.

    PubMed  Google Scholar 

  5. •• Dziegielewski PT, Teknos TN, Durmus K, Old M, Agrawal A, Kakarala K, Marcinow A, Ozer E. Transoral robotic surgery for oropharyngeal cancer long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1099–108. These authors performed a prospective study evaluating predictors of swallowing outcome and quality of life after undergoing TORS for treatment of OPSCC.

  6. More YI, Tsue TT, Girod DA, Harbison J, Sykes KJ, Williams C, Shnayder Y. Functional swallowing outcomes following transoral robotic surgery vs. primary chemoradiotherapy in patients with advanced-stage oropharynx and supraglottic cancers. JAMA Otolaryngol Head Neck Surg. 2013;139:43–8.

    Article  PubMed  Google Scholar 

  7. Weinstein GS, Quon H, Newman J, Chalian JA, Malloy K, Lin A, Desai A, Livolsi VA, Montone KT, Cohen KR, O’Malley BW. Transoral robotic surgery alone for oropharyngeal cancer. Arch Otolaryngol Head Neck Surg. 2012;138(7):628–34.

    Article  PubMed  Google Scholar 

  8. Olsen SM, Moore EJ, Laborde RR, Garcia JJ, Janus JR, Price DL, Olsen KD. Transoral surgery alone for human-papillomavirus-associated oropharyngeal squamous cell carcinoma. Ear Nose Throat J. 2013;92(2):76–83.

    PubMed  Google Scholar 

  9. Shiley SG, Hargunani CA, Skoner JM, et al. Swallowing function after chemoradiation for advanced stage oropharyngeal cancer. Otolaryngol Head Neck Surg. 2006;134:455–9.

    Article  PubMed  Google Scholar 

  10. Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf W, Kolkman-Deurloo IK, Prevost JB, Poll J, Schmitz P, Heijmen BJ. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007;85:64–73.

    Article  PubMed  Google Scholar 

  11. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363:24–35.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Posner MR, Lorch JH, Goloubeva O, Tan M, Schumaker LM, Sarlis NJ, Haddad RI, Cullen KJ. Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial. Ann Oncol. 2011;22:1071–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Quon H, Cohen MA, Montone KT, Ziober AF, Wang LP, Weinstein GS, O’Malley BW Jr. Transoral robotic surgery and adjuvant therapy for oropharyngeal carcinomas and the influence of p16INK4A on treatment outcomes. Laryngoscope. 2013;123:635–40.

    Article  PubMed  Google Scholar 

  14. Stucken CL, de Almeida JR, Sikora AG, Tong CC, Genden EM. The impact of human papillomavirus and smoking on survival outcomes after transoral robotic surgery. Head Neck. 2014;. doi:10.1002/hed.23915.

    PubMed  Google Scholar 

  15. Kaczmar JM, Tan KS, Heitjan DF, Lin A, Ahn PH, Newman JG, Rassekh CH, Chalian AA, O’Malley BW Jr, Cohen RB, Weinstein GS. HPV-related oropharyngeal cancer: risk factors for treatment failure in patients managed with primary surgery (TORS). Head Neck. 2014. doi:10.1002/hed.23850.

  16. Rich JT, Milov S, Lewis JS, Thorstad WL, Adkins DR, Haughey BH. Transoral laser microsurgery ± adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors. Laryngoscope. 2009;119:1709–19.

    Article  PubMed  Google Scholar 

  17. Patel SH, Hinni ML, Hayden RE, Wong WW, Dueck AC, Zarka MA, Curtis KK, Halyard MY. Transoral laser microsurgery followed by radiation therapy for oropharyngeal tumors: the Mayo Clinic Arizona experience. Head Neck. 2014;. doi:10.1002/hed.23279.

    PubMed Central  Google Scholar 

  18. •• Haughey BH, Hinni ML, Salassa JR, Hayden RE, Grant DG, Rich JT, Milov S, Lewis JS, Krishna M. Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: a United States multicenter study. Head Neck. 2011;33(12):1683–94. These authors report outcomes on a large, multi-institutional cohort of patients treated with transoral laser microsurgery and adjuvant treatment and also study the impact of p16 status on patients treated with TLM.

  19. Grant DG, Hinni ML, Salassa JR, Perry WC, Hayden RE, Casler JD. Oropharyngeal cancer a case for single modality treatment with transoral laser microsurgery. Arch Otolaryngol Head Neck Surg. 2009;135:1225–30.

    Article  PubMed  Google Scholar 

  20. Haughey BH, Sinha P. Prognostic factors and survival unique to surgically treated p16 + oropharyngeal cancer. Laryngoscope. 2012;122:S13–33.

    Article  PubMed  Google Scholar 

  21. Chen AM, Daley ME, Luu Q, Donald PJ, Farwell DG. Comparison of functional outcomes and quality of life between transoral surgery and definitive chemoradiotherapy for oropharyngeal cancer. Head Neck. 2014. doi:10.1002/hed.23610.

    Google Scholar 

  22. •• Transoral surgery followed by low-dose or standard-dose radiation therapy with or without chemotherapy in treating patients with HPV positive stage III-IVA oropharyngeal cancer. https://clinicaltrials.gov/ct2/show/NCT01898494 Describes the ECOG 3311 study protocol.

  23. •• Randomized phase II trial of transoral endoscopic head and neck surgery followed by risk-based IMRT and weekly cisplatin versus IMRT and weekly cisplatin for HPV negative oropharynx cancer. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx Describes the RTOG 1221 study protocol.

  24. Cohen MA, Weinstein GS, O’Malley BW Jr, Feldman M, Quon H. Transoral robotic surgery and human papillomavirus status: oncologic results. Head Neck. 2011;33(4):573–80. doi:10.1002/hed.21500.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Enver Ozer.

Additional information

This article is part of the Topical Collection on HPV in Head and Neck Cancer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kang, S.Y., Ozer, E. Primary Surgical Management of Oropharyngeal Squamous Cell Carcinoma. Curr Otorhinolaryngol Rep 3, 79–86 (2015). https://doi.org/10.1007/s40136-015-0082-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-015-0082-0

Keywords

Navigation