surgical management of oropharyngeal cancers kerry d. olsen, m.d. professor, otolaryngology head and...
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Surgical Managementof
Oropharyngeal Cancers
Surgical Managementof
Oropharyngeal Cancers
Kerry D. Olsen, M.D.Professor, Otolaryngology Head
and Neck SurgeryMayo Clinic
Kerry D. Olsen, M.D.Professor, Otolaryngology Head
and Neck SurgeryMayo Clinic
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Advanced Oropharyngeal Cancer
Organ preservation philosophy:
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
• What is the functional benefit of preserving the tonsil or half of the tongue base?
The National Cancer Data Base Report on Squamous Cell Carcinoma of the
Base of TongueHead and Neck May 2004
Largest contemporary overview of presentation cure and outcome for base of tongue SCC
16,188 cases 75% Stage 3, 4(1985-1996)
Treatment % Patients Surgery 16 2,561 Radiation 24 3,972 Surgery + Rad 27 4,354 Rad + Chemo 14 2,342
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Outcome:
• Early stage 1, 2 disease5-year Disease Specific SurvivalSurgery 75%Radiation 46%Rad + Chemo 29%
• Advanced stage 3, 4 disease5-year Disease Specific SurvivalSurgery + Rad 51%Surgery 42%Rad + Chemo 26%Rad 24%
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Tongue BaseSquamous Cell Carcinoma
Tongue BaseSquamous Cell Carcinoma
219 patients – advanced stage 3, 4
• All completed treatment• Disease specific survival 5 yr
Surgery 83%Surgery/RT 60%Chemo/RT 23%
Kowalski, L. M.D.
219 patients – advanced stage 3, 4
• All completed treatment• Disease specific survival 5 yr
Surgery 83%Surgery/RT 60%Chemo/RT 23%
Kowalski, L. M.D.Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Oropharyngeal Cancer
Prevailing opinion:• Surgery
• Difficult to approach• Extensive time commitment• Poor reimbursement• Won’t eat• Leak• Send for alternative therapy
• Reality• Good function in vast majority• Short hospitalization
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Oropharyngeal CancerSurgical Management
In reality, most cases:
• Don’t exhibit bone invasion (mandible)
• Don’t involve the larynx to a significant degree
• Spare one or both hypoglossal nerves
• Don’t involve majority of the soft palate
• Don’t involve carotid artery, para-pharyngeal space/pre-vertebral fascia
• Are accessible surgicallySurgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
102 Patients Tonsil CancerTransoral Excision
Mayo Clinic 1996 – 2004 84% Stage 3, 4 25% S 70% S+R 5% S+R+C 5 yr L – R – D free recurrence
92% - 97% - 91% Overall survival:
• 2 yr 92%
• 5 yr 85%
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Surgical Management Oropharyngeal Cancer No functional benefit to preserve tonsil or ½ tongue
base National Cancer Data Base 2004
• S 2,561 pts R 3,972 pts S+R 4,354 pts R+C 2,342 pts• Stage 1, 2 S 75% R 40% R+C 29%• Stage 3, 4 S+R 51% S 42% R+C 26% R 24%
Five year disease specific survival Stage 3, 4 tongue base cancer – 219 patients by Kowalski
• Disease specific survival 5 yr• S 83% S+R 60% R+C 23%
Tonsil Cancer – 102 patients Mayo Clinic 84% Stage 3, 4• 5 yr L – R – D free recurrence 92% - 97% - 91%• Overall survival 2 yr 92% 5 yr 85%
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008
Surgical Management of Oropharyngeal Cancers
Frankfurt – January 2008