Abstract
Objective: To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design: Case series with chart review. Setting: Tertiary care referral center. Subjects and Methods: We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results: Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P =.004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P =.002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P =.02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion: Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 660-666 |
| Number of pages | 7 |
| Journal | Otolaryngology - Head and Neck Surgery (United States) |
| Volume | 158 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2018 |
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Keywords
- BOT resection
- TORS
- margin status
- margins
- oropharyngeal SCC
- radical tonsillectomy
ASJC Scopus subject areas
- Surgery
- Otorhinolaryngology
Cite this
Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma. / Persky, Michael J.; Albergotti, William Greer; Rath, Tanya J.; Kubik, Mark W.; Abberbock, Shira; Geltzeiler, Mathew; Kim, Seungwon; Duvvuri, Umamaheswar; Ferris, Robert L.
In: Otolaryngology - Head and Neck Surgery (United States), Vol. 158, No. 4, 01.04.2018, p. 660-666.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma
AU - Persky, Michael J.
AU - Albergotti, William Greer
AU - Rath, Tanya J.
AU - Kubik, Mark W.
AU - Abberbock, Shira
AU - Geltzeiler, Mathew
AU - Kim, Seungwon
AU - Duvvuri, Umamaheswar
AU - Ferris, Robert L.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objective: To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design: Case series with chart review. Setting: Tertiary care referral center. Subjects and Methods: We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results: Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P =.004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P =.002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P =.02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion: Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
AB - Objective: To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design: Case series with chart review. Setting: Tertiary care referral center. Subjects and Methods: We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results: Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P =.004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P =.002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P =.02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion: Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
KW - BOT resection
KW - TORS
KW - margin status
KW - margins
KW - oropharyngeal SCC
KW - radical tonsillectomy
UR - http://www.scopus.com/inward/record.url?scp=85045016576&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045016576&partnerID=8YFLogxK
U2 - 10.1177/0194599817742852
DO - 10.1177/0194599817742852
M3 - Article
C2 - 29182490
AN - SCOPUS:85045016576
VL - 158
SP - 660
EP - 666
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
SN - 0194-5998
IS - 4
ER -