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Surgical Management of Oropharyngeal Cancers

Surgical Management of Oropharyngeal Cancers. Kerry D. Olsen, M.D. Professor, Otolaryngology Head and Neck Surgery Mayo Clinic. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008. Advanced Oropharyngeal Cancer. Organ preservation philosophy:.

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Surgical Management of Oropharyngeal Cancers

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  1. Surgical ManagementofOropharyngeal Cancers • Kerry D. Olsen, M.D. • Professor, Otolaryngology Head and Neck Surgery • Mayo Clinic Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

  2. Advanced Oropharyngeal Cancer • Organ preservation philosophy: • What is the functional benefit of preserving the tonsil or half of the tongue base? Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

  3. The National Cancer Data Base Report on Squamous Cell Carcinoma of theBase 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

  4. Outcome: • Early stage 1, 2 disease5-year Disease Specific Survival Surgery 75% Radiation 46% Rad + Chemo 29% • Advanced stage 3, 4 disease5-year Disease Specific Survival Surgery + Rad 51% Surgery 42% Rad + Chemo 26% Rad 24% Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

  5. 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. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

  6. 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

  7. 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 surgically Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

  8. 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

  9. 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

  10. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

  11. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

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