Transcervical approach for oropharyngeal cancer

Introduction. With the advance of new technology like endoscopic laser and robotic surgery the interest in surgical treatment of the oropharyngeal cancer has been icreasing. However, the possibilities of the traditional techniques are not fully understood.

The study objective is to analyze functional and oncologic results of transcervical approach in surgical treatment of oropharyngeal cancer.

Materials and methods. Since April, 2009 through August, 2016 47 patients with oropharyngeal cancer (34 male and 13 female, aged between 44 and 69 years, mean – 57.6) were operated on through the transcervical approach. All but 2 patients with adenoid cystic (1) and acinic cell (1) had squamous cell carcinoma; 27 tumors originated from the tonsil, 13 – from the base of the tongue, 7 – from the soft palate; 42 (89.4 %) patients had stage III–IV disease. Among them 28 (60 %) were diagnosed with T3–T4 primary tumors; 37 (79 %) patients hadmetastases in lymph nodes. Perioperative tracheostomy was performed in all cases. All patients underwent neck dissection that was bilateral in 3 cases. Modified radical was the most frequent type of neck dissection. The operative approach was enhanced by lip-splitting in 12 patients who had marginal mandibulectomy. Local tissues were used for the reconstruction of the pharyngeal defect in 22 patients. In 25 cases flaps were used: free flaps – in 15, regional flaps with axial blood supply – in 10; thereafter 28 patients received adjuvant radiation with or without chemotherapy. Survival was calculated according to Kaplan–Mayer method.

Results. There was 1 death in early postoperative period with the death rate of 2.1 %. Complications were registered in 13 patients (28 %), 4 of them had multiple complications: total or partial flap necrosis – 6, wound infection – 4, postoperative bleeding – 2, perforative duodenal ulcer – 1, gastric bleeding – 1, neck wound breakdown – 1, pharyngeal wound breakdown – 1. Salivary fistula developed in 3 patients (6.5 %). Tracheostomy tube was removed on postoperative day 6.4 on average. In 43 (91.5 %) cases patients were able to resume oral diet 14 days after the operation on average. The mean follow up was 31.1 (3–101) months. Overall 3-year survival was 54.7 % with 63 % locoregional control. Locoregional failure was the most common cause of death – in 13 patients. Among 26 long-term survivors 25 are able to take food orally, 1 (3.8 %) patient remains to be gastrostomy tube dependent.

Conclusion. Transcervical approach for oropharyngeal cancer is a valuable alternative to mandibulotomy because it characterized by acceptable functional results.