Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region -: II.: An analysis of the incidence, related variables, and consequences of local recurrence

Objectives: To determine the incidence of local and regional failure, distant metastasis, and overall survival following transoral lateral oropharyngectomy (TLO) and to determine factors associated with local recurrence. Design: Retrospective case series throughout 20 years; mean follow-up of 10 years. Setting: Academic center. Patients: A total of 166 previously untreated patients with squamous cell carcinoma of the tonsil. Interventions: A total of 131 (81.9%) of the 166 patients received preoperative induction chemotherapy. Fifty-one patients (30.7%) underwent postoperative radiation therapy. Main Outcome Measures: Local and regional recurrence, distant metastasis, second primary tumors, and survival. Results: The 1- and 5-year Kaplan-Meier local control estimates were 91.2% and 82.1%, respectively. The 1- and 5-year Kaplan-Meier local control estimates were 98.3% and 89.0% for T1, 88.9% and 81.7% for T2, and 78.9% and 62.7% for T3 lesions, respectively (P=.02). In univariate analysis, 7 variables were significantly associated with an increased risk of local failure: increasing T classification; positive margins of resection; poor clinical response to induction chemotherapy; tumor spread to the posterior pillar, posterior pharyngeal wall, and contralateral soft palate; and invasion of the junction between the tonsil and soft palate. In a logistic regression model, spread to the posterior pillar was the only variable statistically associated with local failure (P=.02). The 1-, 3-, and 5-year Kaplan-Meier survival estimates were 87.9%, 67.2%, and 57.7%, respectively. The Kaplan-Meier survival estimate was significantly reduced (P =. 009) in patients with local failure. Conclusions: Selected tonsillar squamous cell carcinoma can be managed with TLO with local control comparable to radiotherapy. Patient selection is critical and TLO is best suited for patients with anterior T I to T2 squamous cell carcinoma of the tonsil, without posterior anatomic spread.