Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: Equitable survival and enhanced function compared with contemporary standards of care

Eur J Surg Oncol. 2020 Nov;46(11):2042-2049. doi: 10.1016/j.ejso.2020.06.045. Epub 2020 Jul 22.

Abstract

Introduction: We describe the 5-year oncological and functional outcomes of transoral laser microsurgery, neck dissection (TLM + ND) and adjuvant radiotherapy (PORT) used to treat patients with oropharyngeal carcinoma. The effectiveness of external carotid artery (ECA) ligation in reducing post-operative bleeding, and fibrin glue following ND in reducing wound drainage and length of hospital stay is reported.

Materials and methods: This retrospective case review of consecutive patients undergoing TLM between 2006 and 2017 used the Kaplan-Meier Estimator and Log-Rank Test for univariate, time-to-event analyses, and Cox-Proportionate Hazard modelling for multivariate analysis.

Results: 264 consecutive patients were included. Mean follow-up was 49.4 months. 219 (82.9%) patients received PORT. Five-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 74.9%, 73.7%, and 86.2%, respectively. Five-year locoregional control was 89.4%. 65.5% of cases were Human papillomavirus associated (HPV+), for whom OS, DFS and DSS was 85.6%, 84.7% and 92.7%, respectively, and demonstrated significantly higher OS (hazard ratio (HR) 0.28, CI 0.16-0.49, p < 0.0001), DFS (HR 0.28, CI 0.17-0.47, p < 0.0001) and DSS (HR 0.2, CI 0.09-0.44, <0.001). Post-operative oropharyngeal bleeding occurred in 23 patients (8.7%), of which 5 were major/severe, in patients without ECA ligation. Fibrin glue significantly reduced neck drain output (p < 0.001), and length of hospital stay (p < 0.001). One-year gastrostomy dependence rate was 2.3%.

Conclusions: TLM + ND + PORT results in favourable 5-year survival and locoregional control rates, and low feeding tube dependency rates. ECA ligation and fibrin glue appear to reduce major post-operative haemorrhage, wound drainage and length of hospital stay.

Keywords: External carotid artery; Fibrin glue; Human papillomavirus; Oropharyngeal squamous cell cancer; Swallowing; Transoral laser microsurgery.

MeSH terms

  • Carotid Artery, External / surgery
  • Deglutition
  • Deglutition Disorders / epidemiology*
  • Deglutition Disorders / therapy
  • Disease-Free Survival
  • Female
  • Fibrin Tissue Adhesive / therapeutic use
  • Gastrostomy
  • Humans
  • Laser Therapy / methods*
  • Length of Stay / statistics & numerical data
  • Ligation
  • Male
  • Microsurgery / methods*
  • Mouth
  • Neck Dissection / methods*
  • Oropharyngeal Neoplasms / mortality
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / surgery*
  • Papillomavirus Infections
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / therapy
  • Postoperative Hemorrhage / prevention & control
  • Proportional Hazards Models
  • Radiotherapy, Adjuvant*
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck / mortality
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / surgery*
  • Survival Rate
  • Tissue Adhesives / therapeutic use
  • Treatment Outcome
  • Wound Closure Techniques

Substances

  • Fibrin Tissue Adhesive
  • Tissue Adhesives