Submandibular gland preservation during concurrent neck dissection and transoral surgery for oropharyngeal squamous cell carcinoma.
OBJECTIVE
Analyze the effect of ipsilateral submandibular gland preservation on patients undergoing concurrent neck dissection and transoral surgery for oropharyngeal squamous cell carcinoma. Evaluate for (1) intraoperative and postoperative communications between the oropharynx and neck and (2) oncologic outcomes.


METHODS
Retrospective chart review of prospectively collected data.


METHODS
Tertiary academic referral center.


METHODS
Retrospective chart review of patients undergoing transoral laser resection of oropharyngeal squamous cell carcinoma with simultaneous neck dissection(s) for primary, persistent, recurrent, and second primary disease between January 1999 and February 2013. Data analyzed for operative technique, pathologic diagnosis, postoperative course, complications, and oncologic outcomes.


RESULTS
Overall 253 patients were identified. Of these, 96 patients underwent ipsilateral submandibular gland preservation and 157 underwent ipsilateral submandibular gland removal at the time of neck dissection. The prevalence of intraoperative communication between the neck and oropharynx was significantly lower in cases with submandibular gland preservation (2/96, 2.08%) compared to those with submandibular gland removal (22/157, 14.13%). No postoperative leaks occurred in the gland preservation group (0/96, 0%) compared to a leak prevalence of 8.92% (14/157) when the gland was removed (P = .0041). There was no difference in local, regional, or distant disease recurrence between submandibular gland preservation and gland removal. Similarly, Kaplan-Meier analysis showed no difference in disease free survival, disease specific survival, or overall survival.


CONCLUSIONS
Submandibular gland preservation during neck dissection in patients undergoing transoral surgery for oropharyngeal squamous cell carcinoma significantly reduces the risk of intraoperative and postoperative salivary leaks without compromising oncologic outcomes.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Brittany E
BE
Howard
Michael L
ML
Hinni
Thomas H
TH
Nagel
Yu-Hui
YH
Chang
Meng-Ru
MR
Cheng
Richard E
RE
Hayden
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D009926:Organ Preservation; D059351:Organ Sparing Treatments / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D013363:Submandibular Gland; D016019:Survival Analysis; D016896:Treatment Outcome
disease free survival; disease specific survival; head and neck cancer; laser; oropharyngeal neoplasms; overall survival; robotics; squamous cell carcinoma; squamous cell neoplasms; submandibular gland; transoral laser microsurgery; transoral robotic surgery; transoral surgery