Effect of palatine tonsil tumor resection on postoperative velopharyngeal insufficiency in transoral surgery

Background Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV‐mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes. Methods This retrospective study was exemp...

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Published in:Head & neck 2024-05, Vol.46 (5), p.1178-1188
Main Authors: Wistermayer, Paul R., Brown, Adam E., Cave, Taylor B., Chang, Brent A., Hinni, Michael L., Hayden, Richard E., Klusovsky, Laura E., McGary, Alyssa, Nagel, Thomas H.
Format: Article
Language:English
Subjects:
Multivariate analysis
Palate
palate preservation
Patients
Pharynx
Risk factors
robotic surgery
Squamous cell carcinoma
Surgery
Throat cancer
TORS
TORS technique
transoral surgery
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container_end_page 1188
container_issue 5
container_start_page 1178
container_title Head & neck
container_volume 46
creator Wistermayer, Paul R.
Brown, Adam E.
Cave, Taylor B.
Chang, Brent A.
Hinni, Michael L.
Hayden, Richard E.
Klusovsky, Laura E.
McGary, Alyssa
Nagel, Thomas H.
description Background Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV‐mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes. Methods This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated. Results Fifty‐five patients were included. Mean and median follow‐up was 34 months. 98% of patients were AJCC stage I/II. Recurrence‐free survival was 96% with no local recurrences. Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p 
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Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes. Methods This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated. Results Fifty‐five patients were included. Mean and median follow‐up was 34 months. 98% of patients were AJCC stage I/II. Recurrence‐free survival was 96% with no local recurrences. Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p &lt; 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009). Conclusion Loss of soft palate pharyngeal attachments is an independent risk factor for VPI. When oncologically appropriate, the palatal attachments to the pharynx may be preserved.</description><identifier>ISSN: 1043-3074</identifier><identifier>ISSN: 1097-0347</identifier><identifier>EISSN: 1097-0347</identifier><identifier>DOI: 10.1002/hed.27741</identifier><identifier>PMID: 38506149</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley &amp; Sons, Inc</publisher><subject>Multivariate analysis ; Palate ; palate preservation ; Patients ; Pharynx ; Risk factors ; robotic surgery ; Squamous cell carcinoma ; Surgery ; Throat cancer ; TORS ; TORS technique ; transoral surgery</subject><ispartof>Head &amp; neck, 2024-05, Vol.46 (5), p.1178-1188</ispartof><rights>2024 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3131-917d8ff7d48c8180cbfecda2c230799bdd94c576c5f476d54621dba7595b6c3f3</cites><orcidid>0000-0002-1859-0913</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38506149$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wistermayer, Paul R.</creatorcontrib><creatorcontrib>Brown, Adam E.</creatorcontrib><creatorcontrib>Cave, Taylor B.</creatorcontrib><creatorcontrib>Chang, Brent A.</creatorcontrib><creatorcontrib>Hinni, Michael L.</creatorcontrib><creatorcontrib>Hayden, Richard E.</creatorcontrib><creatorcontrib>Klusovsky, Laura E.</creatorcontrib><creatorcontrib>McGary, Alyssa</creatorcontrib><creatorcontrib>Nagel, Thomas H.</creatorcontrib><title>Effect of palatine tonsil tumor resection on postoperative velopharyngeal insufficiency in transoral surgery</title><title>Head &amp; neck</title><addtitle>Head Neck</addtitle><description>Background Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV‐mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes. Methods This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated. Results Fifty‐five patients were included. Mean and median follow‐up was 34 months. 98% of patients were AJCC stage I/II. Recurrence‐free survival was 96% with no local recurrences. Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p &lt; 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009). Conclusion Loss of soft palate pharyngeal attachments is an independent risk factor for VPI. When oncologically appropriate, the palatal attachments to the pharynx may be preserved.</description><subject>Multivariate analysis</subject><subject>Palate</subject><subject>palate preservation</subject><subject>Patients</subject><subject>Pharynx</subject><subject>Risk factors</subject><subject>robotic surgery</subject><subject>Squamous cell carcinoma</subject><subject>Surgery</subject><subject>Throat cancer</subject><subject>TORS</subject><subject>TORS technique</subject><subject>transoral surgery</subject><issn>1043-3074</issn><issn>1097-0347</issn><issn>1097-0347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp1kU1LxDAQhoMofqwe_AMS8KKHuvlq0xxF1w8QvOg5pGmikWxSk3Zl_73R1YsgDGQm8_AyMy8AxxhdYITI_NX0F4RzhrfAPkaCV4gyvv2VM1pRxNkeOMj5DSFEG0Z2wR5ta9RgJvaBX1hr9AijhYPyanTBwDGG7Dwcp2VMMJlc-i4GWGKIeYyDSYVbGbgyPg6vKq3Di1EeupAna512Juh1qeCYVMgxlVae0otJ60OwY5XP5ujnnYHnm8XT1V318Hh7f3X5UGmKKa4E5n1rLe9Zq1vcIt2VEXtFNCm7CNH1vWC65o2uLeNNX7OG4L5TvBZ112hq6QycbXSHFN8nk0e5dFkb71UwccqSCE44oqImBT39g77FKYUynaTlig0VuGaFOt9QOsWck7FySG5ZNpcYyS8LZLFAfltQ2JMfxalblt9f8vfmBZhvgA_nzfp_JXm3uN5IfgIaHZH4</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Wistermayer, Paul R.</creator><creator>Brown, Adam E.</creator><creator>Cave, Taylor B.</creator><creator>Chang, Brent A.</creator><creator>Hinni, Michael L.</creator><creator>Hayden, Richard E.</creator><creator>Klusovsky, Laura E.</creator><creator>McGary, Alyssa</creator><creator>Nagel, Thomas H.</creator><general>John Wiley &amp; Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1859-0913</orcidid></search><sort><creationdate>202405</creationdate><title>Effect of palatine tonsil tumor resection on postoperative velopharyngeal insufficiency in transoral surgery</title><author>Wistermayer, Paul R. ; Brown, Adam E. ; Cave, Taylor B. ; Chang, Brent A. ; Hinni, Michael L. ; Hayden, Richard E. ; Klusovsky, Laura E. ; McGary, Alyssa ; Nagel, Thomas H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3131-917d8ff7d48c8180cbfecda2c230799bdd94c576c5f476d54621dba7595b6c3f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Multivariate analysis</topic><topic>Palate</topic><topic>palate preservation</topic><topic>Patients</topic><topic>Pharynx</topic><topic>Risk factors</topic><topic>robotic surgery</topic><topic>Squamous cell carcinoma</topic><topic>Surgery</topic><topic>Throat cancer</topic><topic>TORS</topic><topic>TORS technique</topic><topic>transoral surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wistermayer, Paul R.</creatorcontrib><creatorcontrib>Brown, Adam E.</creatorcontrib><creatorcontrib>Cave, Taylor B.</creatorcontrib><creatorcontrib>Chang, Brent A.</creatorcontrib><creatorcontrib>Hinni, Michael L.</creatorcontrib><creatorcontrib>Hayden, Richard E.</creatorcontrib><creatorcontrib>Klusovsky, Laura E.</creatorcontrib><creatorcontrib>McGary, Alyssa</creatorcontrib><creatorcontrib>Nagel, Thomas H.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Head &amp; neck</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wistermayer, Paul R.</au><au>Brown, Adam E.</au><au>Cave, Taylor B.</au><au>Chang, Brent A.</au><au>Hinni, Michael L.</au><au>Hayden, Richard E.</au><au>Klusovsky, Laura E.</au><au>McGary, Alyssa</au><au>Nagel, Thomas H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of palatine tonsil tumor resection on postoperative velopharyngeal insufficiency in transoral surgery</atitle><jtitle>Head &amp; neck</jtitle><addtitle>Head Neck</addtitle><date>2024-05</date><risdate>2024</risdate><volume>46</volume><issue>5</issue><spage>1178</spage><epage>1188</epage><pages>1178-1188</pages><issn>1043-3074</issn><issn>1097-0347</issn><eissn>1097-0347</eissn><abstract>Background Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV‐mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes. Methods This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated. Results Fifty‐five patients were included. Mean and median follow‐up was 34 months. 98% of patients were AJCC stage I/II. Recurrence‐free survival was 96% with no local recurrences. Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p &lt; 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009). Conclusion Loss of soft palate pharyngeal attachments is an independent risk factor for VPI. 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subjects Multivariate analysis
Palate
palate preservation
Patients
Pharynx
Risk factors
robotic surgery
Squamous cell carcinoma
Surgery
Throat cancer
TORS
TORS technique
transoral surgery
title Effect of palatine tonsil tumor resection on postoperative velopharyngeal insufficiency in transoral surgery
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