Department of Otolaryngology - Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A.
Department of Otorhinolaryngology, The University of Alabama School of Medicine, Birmingham, Alabama, U.S.A.
Laryngoscope. 2023 May;133(5):1132-1137. doi: 10.1002/lary.30275. Epub 2022 Jul 9.
Evaluate the effect of initial incision margins (IIM) on clinical outcomes after transoral robotic surgery (TORS) for human papillomavirus positive (HPV+) squamous cell cancers of the oropharynx (OPSCC).
Retrospective chart review of patients undergoing TORS for HPV+ OPSCC from 2007 to 2015 was performed. Overall survival (OS), disease-specific survival (DSS), recurrence, and metastases were evaluated in the context of pathology, IIM, final margins, adjuvant therapy, and patient characteristics.
Ninety-five patients with HPV+ OPSCC undergoing primary surgery were identified. 88% of these patients had no evidence of disease at the conclusion of the study (average follow-up 45 months). Twenty were identified that had true positive IIM and 16 had very close IIM, with the remainder demonstrating widely negative margins. Tumor very close to or involving the deep margin but not a mucosal margin was associated with a higher risk of recurrence. Perineural invasion and lymphovascular invasion were associated with positive IIM. Positive or very close IIM on the deep margin was found to impact DSS and recurrence.
Obtaining negative IIM while performing TORS for HPV+ OPSCC is a modifiable factor that affects recurrence and DSS. Larger surgical margins should be considered in patients with perineural invasion or whose tumor abuts the initial deep margin.
4 Laryngoscope, 133:1132-1137, 2023.
评估经口机器人手术（TORS）治疗人乳头瘤病毒阳性（HPV+）口咽鳞状细胞癌（OPSCC）时初始切缘（IIM）对临床结果的影响。
对 2007 年至 2015 年接受 TORS 治疗 HPV+OPSCC 的患者进行回顾性图表审查。根据病理、IIM、最终切缘、辅助治疗和患者特征评估总生存率（OS）、疾病特异性生存率（DSS）、复发和转移。
确定了 95 例接受原发性手术治疗的 HPV+OPSCC 患者。在研究结束时，88%的患者无疾病证据（平均随访 45 个月）。20 例患者的 IIM 为真阳性，16 例患者的 IIM 非常接近，其余患者的切缘均为广泛阴性。肿瘤非常接近或累及深部切缘但不涉及黏膜切缘与复发风险增加相关。神经周围侵犯和血管淋巴管侵犯与 IIM 阳性相关。深部切缘上的阳性或非常接近的 IIM 被发现影响 DSS 和复发。
在进行 HPV+OPSCC 的 TORS 时获得阴性的 IIM 是一个可改变的因素，会影响复发和 DSS。对于有神经周围侵犯或肿瘤紧贴初始深部切缘的患者，应考虑更大的手术切缘。
4 级喉镜，133：1132-1137，2023 年。
