Transoral surgery (TOS) in oropharyngeal cancer: Different tools, a single mini-invasive philosophy

• Published in: Surgical oncology 2018-12, Vol.27 (4), p.643-649
• Main Authors: Tirelli, Giancarlo, Boscolo Nata, Francesca, Piovesana, Marco, Quatela, Eliana, Gardenal, Nicoletta, Hayden, Richard E.
• Format: Article
• Language: English
• Subjects: Cancer; Cancer therapies; Chemotherapy; Endoscopy; Humans; Innovations; Invasiveness; Larynx; Laser Therapy - methods; Lasers; Literature reviews; Medical equipment; Microsurgery; Minimally Invasive Surgical Procedures - methods; Natural Orifice Endoscopic Surgery - methods; Oral cavity; Oropharyngeal cancer; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - surgery; Pharynx; Philosophy; Quality of life; Radiation therapy; Robotic surgery; Robotic Surgical Procedures - methods; Surgeons; Surgery; Surgical instruments; Terminology; Throat cancer; Transoral laser microsurgery; Transoral robotic surgery; Transoral surgery; Transoral ultrasound surgery; Transoral videolaryngoscopic surgery; Tumors; Ultrasonic imaging; Ultrasound; Visualization
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2018.08.003

Surgery with or without adjuvant therapy and radiotherapy with or without chemotherapy have traditionally represented the possible treatment options for oropharyngeal cancer. The adverse effects of non-surgical treatments and recent technical innovations have prompted a new interest in the surgical approach. However, in parallel to the possibility of achieving radical cancer clearance, we should remember the impact that traditional open surgery has on the patient's cosmesis, functionality and quality of life. As a result, transoral surgery is an attractive option for oropharyngeal tumors. The term “transoral surgery” only indicates that the tumor is accessed and resected via the oral cavity, but the surgeon can choose among different resection methods, such as transoral laser microsurgery, transoral robotic surgery, transoral videolaryngoscopic surgery, endoscopic laryngo-pharyngeal surgery, and transoral ultrasound surgery. The aim of this paper is to review the recent literature on the transoral treatment of oropharyngeal cancer, to standardize the terminology of transoral procedures, analyzing the common aspects, main differences and future perspectives of the various forms of transoral surgery. •Perfect surgical exposure is a prerequisite to perform a safe transoral surgery.•Endoscopes as magnification instruments provide wider surgical field than microscope.•Inside-out anatomy allows identifying anatomic structures preventing complications.•Accurate margin analysis is crucial with both en bloc or piecemeal resection.•The timing of neck dissection is still a matter of debate.