Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
Head Neck. 2021 Aug;43(8):2434-2444. doi: 10.1002/hed.26708. Epub 2021 Apr 15.
The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear.
Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan-Meier method.
Ninety-nine patients were included (median follow-up 21 months, range 6-121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins.
Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.
HPV 相关口咽鳞状细胞癌（HPV+OPSCC）中，手术切缘接近对肿瘤学结果的影响尚不清楚。
这是一项回顾性病例系列研究，纳入了 2010 年至 2019 年期间在三个学术医疗中心接受单一模式经口机器人手术（TORS）治疗的 HPV+OPSCC 患者。使用 Kaplan-Meier 法比较切缘接近（<1mm 或需要再次切除）和切缘清晰的患者的结局。
共纳入 99 例患者（中位随访时间 21 个月，范围 6-121 个月）。22 例（22.2%）患者的最终切缘接近，75 例（75.8%）患者的切缘清晰，2 例（2.0%）患者的切缘阳性。8 例（8.1%）患者复发，包括 2 例局部复发（2.0%）。4 例患者在研究期间死亡（4.0%）。局部控制（p=0.470）、无病生存率（p=0.513）和总生存率（p=0.064）在切缘接近和切缘清晰的患者之间无差异。
对于接受 TORS 治疗的 HPV+OPSCC 患者，如果没有辅助治疗的指征，且切缘接近，可考虑单独观察。
