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Surgical Perspective in the Management of Oropharyngeal Cancer

  • Neil Gildener-LeapmanEmail author
  • Seungwon Kim
Chapter
  • 754 Downloads

Abstract

Transoral robotic surgery is the primary method for resection of oropharyngeal malignancies when primary chemoradiation is not employed. There are multiple methods of resecting the oropharynx in primary and recurrent disease including open approaches, direct line of sight electrocautery, transoral laser microsurgery (TLM), and transoral robotic surgery (TORS). Details of TORS technique are reviewed from surgical site exposure to steps of resection, hemostasis, and reconstruction. Oncologic outcomes are excellent when TORS is combined with adjuvant therapy as appropriate. Overall two-year survival with TORS is between 82 and 94 % and positive margin rate is approximately 6 %. TORS has a distinct set of complications when compared to chemoradiation, with oropharyngeal hemorrhage being a rare but devastating event. Because oncologic outcomes are excellent in oropharyngeal cancer quality of life (QOL) measures are of primary importance when choosing a treatment modality. New trials are opening to investigate how TORS can play a role in changing QOL outcomes and treatment de-escalation. While treatment principles will remain similar for the foreseeable future, new flexible robotic technology may allow for improved surgical exposure in difficult patients.

Keywords

Oropharyngeal cancer TORS Chemoradiation Quality of life Transoral laser microsurgery Oropharyngeal hemorrhage Local and free-flap reconstruction Recurrent cancer 

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of OtolaryngologyNew York Eye and Ear Infirmary of Mount SinaiNew York CityUSA
  2. 2.Department of OtolaryngologyEye & Ear Institute, University of PittsburghPittsburghUSA

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