title: Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach.
abstract: The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM).
  
  
  
  A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high-risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan-Meier statistics.
  
  
  
  Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV-positive (n = 101; 66.0%). Three-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV-positivity portended favorable oncologic outcomes. One-year gastrostomy tube (G-tube) dependency was 1.3%.
  
  
  
  To the best of our knowledge, this is the largest single-center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/- postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263-1270, 2016.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.|Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Wilkie
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.|Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Navdeep S
authors.initials: NS
authors.lastname: Upile
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.|Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Lau
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Williams
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.|Department of Pathology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Sheard
authors.affiliation: Department of Pathology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Tim R
authors.initials: TR
authors.lastname: Helliwell
authors.affiliation: Centre for Oral Health Research, Newcastle University, Newcastle, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Robinson
authors.affiliation: Department of Anaesthetics, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rodrigues
authors.affiliation: Department of Anaesthetics, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Krishna
authors.initials: K
authors.lastname: Beemireddy
authors.affiliation: Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Huw
authors.initials: H
authors.lastname: Lewis-Jones
authors.affiliation: Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hanlon
authors.affiliation: The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Husband
authors.affiliation: The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom.
authors.forename: Aditya
authors.initials: A
authors.lastname: Shenoy
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Roland
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Shaun R
authors.initials: SR
authors.lastname: Jackson
authors.affiliation: Department of Oral and Maxillofacial Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Fazilet
authors.initials: F
authors.lastname: Bekiroglu
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Sankalap
authors.initials: S
authors.lastname: Tandon
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lancaster
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.|Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy / Q000379:methods* / Q000401:mortality; D008297:Male; D008866:Microsurgery / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom
keywords: carcinoma; laser therapy/methods; local; neoplasm recurrence; oropharyngeal neoplasms/mortality; oropharyngeal neoplasms/surgery; squamous cell/surgery; survival analysis