Transoral resection of tonsillar squamous cell carcinoma

Abstract

The tonsillar fossa is the most common subsite of the oropharynx to be afflicted with squamous cell carcinoma (SCCA). Accepted treatments include any combination of surgery, radiotherapy, and chemotherapy. We review the oncologic and functional outcomes of patients with tonsillar carcinoma who underwent transoral tumor resection and neck dissection with or without postoperative radiotherapy or chemoradiotherapy. Retrospective chart review. From 1996 through January 2005, 102 patients with tonsillar SCCA underwent transoral resection. Overall survival, disease-specific survival, local control, and locoregional control rates were analyzed using the Kaplan-Meier method. Immediate and long-term speech and swallowing function and treatment-related morbidity were analyzed. Twenty-six patients had surgery only, 71 had surgery and radiotherapy, and five had surgery and chemoradiotherapy. Twenty patients had stage III disease, 63 had stage IVA disease, and two had stage IVB disease. The Kaplan-Meier overall survival estimate was 92.2% at 2 years and 85.0% at 5 years. The 5-year local control estimate was 91.8%, and the 5-year Kaplan-Meier disease-specific survival estimate was 93.9%. The median hospital stay was 3 days. Tracheostomy was required for 14 patients, and 13 of these patients had decannulation. Temporary feeding tubes were placed in 35 patients. Sixteen patients received a percutaneous endoscopic gastrostomy tube; of these, 12 had the tubes removed. Transoral resection of tonsillar SCCA with or without postoperative adjuvant therapy provided excellent locoregional control and minimized treatment-related morbidity. We believe that transoral resection is the optimal treatment for patients with oropharyngeal SCCA.