Journal
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
Volume 38, Issue 3, Pages 402-409Publisher
WILEY-BLACKWELL
DOI: 10.1002/hed.23909
Keywords
oropharyngeal cancer; transoral robotic surgery (TORS); transoral laser microsurgery (TLM); national cancer database; surgical margins
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Funding
- University of Pennsylvania Leonard Davis Institute of Health Economics
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BackgroundTransoral endoscopic surgery is a promising new treatment for oropharyngeal squamous cell carcinoma (SCC). MethodsWe examined care patterns and outcomes in 514 patients with oropharyngeal SCC undergoing transoral endoscopic surgery within the 2010 to 2011 National Cancer Database (NCDB). ResultsMost patients had T1 to T2 tumors (88.5%), and were treated in academic facilities (64.2%). Mean length of hospitalization was 5.1 days and perioperative mortality was 0.8%. Final surgical margins were positive in 20% of patients, and were more common with T2 (odds ratio [OR] = 2.35; p < .05) or N2 disease (OR = 4.18; p < .001), treatment in community cancer centers (OR = 1.81; p < .05), and low volume centers (OR = 2.43; p < .05). ConclusionEarly adoption of transoral surgery for oropharyngeal SCC had an excellent safety profile. We observed higher rates of positive surgical margins than previously reported. These findings highlight the importance of surgeon experience and patient selection, and suggest that transoral endoscopic surgery for oropharyngeal SCC be performed by highly trained surgeons in the context of multidisciplinary care. (c) 2015 Wiley Periodicals, Inc. Head Neck 38: 402-409, 2016
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