Abstract
ObjectiveTo investigate a novel surgical approach of combined transcervical parapharyngeal space (PPS) with the transoral approach to dissect oropharyngeal cancer.Methods31 patients who were pathologically diagnosed with oropharyngeal cancer and had undergone surgical treatment in Beijing Tongren Hospital during June 2018 and December 2020 were enrolled. All patients were squamous cell carcinoma patients. There were 25 males and 6 females, and the age ranged between 44 and 70 years old. The number of patients with T1, T2, T3, and T4 stage disease was 8, 15, 8, and 0, respectively, according to the American Joint Committee on Cancer staging method, 8th edition. After the dissection of the submandibular and cervical lymph nodes, the parapharyngeal space was exposed, and the parapharyngeal space lymph node and the outer borderline of the tumor were dissected, and then the inner borderline of the tumor was dissected via a transoral approach; the tumor was dissected en bloc, and the defects were reconstructed with the flap from the neck through the parapharyngeal space.ResultsAmong the patients enrolled, 21 were HPV positive and 10 were HPV negative. 8 patients were free of lymph node metastasis. The tumor resection margins were negative in all 31 patients. Safe and sufficient excision of tumors was feasible by this new surgical approach, avoiding complications associated with mandibulotomy or lip-splitting. All patients had no obvious dysfunctions of swallowing and voice. By the time of this follow-up, none died caused by OPSCC, and only two patients suffered from local recurrence. The 3-year survival rate is 100%, and the 3-year recurrence-free survival rate is 84.58%.ConclusionThe surgical approach of combined transcervical parapharyngeal space with the transoral approach was effective and safe. On this basis, this approach has the advantage of fewer postoperative complications and better functional results.
Highlights
Oropharyngeal cancers occur in the palatine and lingual tonsils, the base of the tongue, the soft palate, and the posterior pharyngeal wall
Postoperative complications occurred in 4 patients (12.9%): two developed pharyngocutaneous fistula (PCF) and recovered after a period of dressing changes
concurrent chemoradiation therapy (CCRT) has its own advantages in maintaining the same survival outcomes while protecting patients against the trauma of surgical intervention [6], whereas the long-term complications caused by chemoradiotherapy, such as limited mouth opening and dysphagia, will severely affect patients’ quality of life
Summary
Oropharyngeal cancers occur in the palatine and lingual tonsils, the base of the tongue, the soft palate, and the posterior pharyngeal wall. The most common type is oropharyngeal squamous cell carcinoma (OPSCC). The incidence of OPSCC has increased annually in recent years, especially accompanied by the increase of HPV-related OPSCC [1]. The treatment of OPSCC has been updated and improved all the time. Since the 1990s, concurrent chemoradiation therapy (CCRT) has become the standard treatment for OPSCC, especially for the locally advanced OPSCC. There are many side effects of CCRT. Patients often suffer from acute and late toxicities, which can lead to dysphagia and other dysfunctions [2]
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