دورية أكاديمية
أعرض في EDS

TORS elective lingual tonsillectomy has less acute morbidity than therapeutic base of tongue TORS.

التفاصيل البيبلوغرافية
العنوان: TORS elective lingual tonsillectomy has less acute morbidity than therapeutic base of tongue TORS.
المؤلفون: Patel MR; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: Mihir.r.patel@emory.edu., Ottenstein L; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States., Ryan M; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States., Farrell A; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States., Studer M; Emory University School of Medicine, Atlanta, GA, United States., Baddour HM; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States., Magliocca K; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States., Griffith C; Department of Pathology, Cleveland Clinic, Cleveland, OH, United States., Stokes W; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States., Switchenko J; Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA, United States., Aiken A; Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, GA, United States., El-Deiry M; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States., Solares CA; Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States., Steuer C; Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States., Saba N; Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States., Beitler J; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States.
المصدر: Oral oncology [Oral Oncol] 2021 Jun; Vol. 117, pp. 105294. Date of Electronic Publication: 2021 Apr 17.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: England NLM ID: 9709118 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0593 (Electronic) Linking ISSN: 13688375 NLM ISO Abbreviation: Oral Oncol Subsets: MEDLINE
أسماء مطبوعة: Publication: Amsterdam : Elsevier
Original Publication: Oxford ; New York : Pergamon, c1997-
مواضيع طبية MeSH: Head and Neck Neoplasms*/surgery , Neoplasms, Unknown Primary*/surgery , Squamous Cell Carcinoma of Head and Neck*/surgery , Tonsillectomy*/adverse effects , Tonsillectomy*/methods, Deglutition Disorders/etiology ; Humans ; Margins of Excision ; Morbidity ; Postoperative Complications ; Retrospective Studies
مستخلص: Objective: To determine the impact of diagnostic TORS lingual tonsillectomy (DTLT) on objective swallowing measures for carcinoma of unknown primary (CUP).
Methods: Between 10/2016-1/2020, 27 patients with p16+ squamous cell carcinoma (SCC) level 2a nodal disease underwent DTLT and ipsilateral neck dissection for CUP. No patient had a history of cutaneous SCC. Patients participated in Modified Barium Swallow (MBS) three weeks post-TORS, which were then compared to those from a contemporaneous cohort of 40 patients with clinically-identified p16+ base of tongue (BOT) primary tumors. DIGEST scores were retrospectively calculated. Univariate and multivariate analysis performed, stratified by BOT glossectomy (n = 40) versus lingual tonsillectomy for CUP (n = 27). Radiation to the resected primary or potential primary sources was omitted if margins were ≥3 mm or if no primary identified.
Results: Twenty-seven consecutive patients with clinical stage cT0N1 HPV-associated OPSCC had a BOT primary pathologically identified in 18/27 (67%). Univariate analysis of functional swallow assessment on MBSImP correlated with improved post-TORS DIGEST scores for CUP. On multivariate analysis (MVA) DIGEST safety scores were improved for CUP than cT1 BOT glossectomy [Odds Ratio (OR) 0.28, p = 0.038]. MVA on matched pT1 CUP (n = 27) vs. pT1 BOT (n = 19), OR of moderate/severe dysphagia for CUP was 0.54 [0.12-2.38, p = 0.417] for DIGEST safety scores and 0.27 [0.06-1.18, p = 0.082] for DIGEST efficiency scores. Moderate/severe dysphagia as determined by DIGEST overall scores for CUP compared to cT1 and pT1 yielded an OR of 0.39 (p = 0.081) and 0.42 (p = 0.195), respectively. Twenty-six total patients received adjuvant RT, and 18 (11 with ≥3 mm margins, 9 with negative specimens) were spared intentional RT to the oropharynx. Median follow-up was 22.6 months with 100% PFS.
Conclusions: Patients undergoing DTLT for CUP demonstrated acute swallow defecits in the post-operative setting. A comparison of long-term functional results between DTLT and elective irradiation of the primary site should be studied.
Level of Evidence: Level III.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
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معلومات مُعتمدة: P30 CA138292 United States CA NCI NIH HHS
فهرسة مساهمة: Keywords: CUP; DIGEST; HPV; Lingual tonsillectomy; Modified Barium Swallow Study; TORS; Unknown primary
تواريخ الأحداث: Date Created: 20210420 Date Completed: 20220131 Latest Revision: 20220131
رمز التحديث: 20240829
مُعرف محوري في PubMed: PMC8281337
DOI: 10.1016/j.oraloncology.2021.105294
PMID: 33878679
قاعدة البيانات: MEDLINE
الوصف
تدمد:1879-0593
DOI:10.1016/j.oraloncology.2021.105294