title: Patterns of care and perioperative outcomes in transoral endoscopic surgery for oropharyngeal squamous cell carcinoma.
abstract: BACKGROUND
  Transoral endoscopic surgery is a promising new treatment for oropharyngeal squamous cell carcinoma (SCC).
  
  
  METHODS
  We examined care patterns and outcomes in 514 patients with oropharyngeal SCC undergoing transoral endoscopic surgery within the 2010 to 2011 National Cancer Database (NCDB).
  
  
  RESULTS
  Most patients had T1 to T2 tumors (88.5%), and were treated in academic facilities (64.2%). Mean length of hospitalization was 5.1 days and perioperative mortality was 0.8%. Final surgical margins were positive in 20% of patients, and were more common with T2 (odds ratio [OR] = 2.35; p < .05) or N2 disease (OR = 4.18; p < .001), treatment in community cancer centers (OR = 1.81; p < .05), and low volume centers (OR = 2.43; p < .05).
  
  
  CONCLUSIONS
  Early adoption of transoral surgery for oropharyngeal SCC had an excellent safety profile. We observed higher rates of positive surgical margins than previously reported. These findings highlight the importance of surgeon experience and patient selection, and suggest that transoral endoscopic surgery for oropharyngeal SCC be performed by highly trained surgeons in the context of multidisciplinary care.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Zevallos
authors.affiliation: Department of Biostatistics and Epidemiology, Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.affiliation: Department of Radiation Oncology, Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Samuel
authors.initials: S
authors.lastname: Swisher-McClure
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: national cancer database; oropharyngeal cancer; surgical margins; transoral laser microsurgery (TLM); transoral robotic surgery (TORS)