title: The Hybrid Transoral-Pharyngotomy Approach to Oropharyngeal Carcinoma: Technique and Outcome.
abstract: BACKGROUND
  The indications, techniques, and outcomes for a minimally invasive surgical approach in oropharyngeal squamous cell carcinoma (OPSCC) unsuitable for transoral resection are not well-described.
  
  
  METHODS
  A retrospective case series was performed using a prospectively assembled database of transoral surgery-treated OPSCC patients who also underwent a "hybrid" approach of combined transoral and limited pharyngotomy for tumor resection. Disease and functional outcomes were evaluated.
  
  
  RESULTS
  Twenty patients underwent complete tumor resection using the hybrid approach. Median follow-up was 48 months. No postoperative pharyngocutaneous fistula occurred. One patient (5%) had a local recurrence. Kaplan-Meier estimates for disease-specific survival at 2 and 5 years were 94.4% (95% CI, 84%-100%) and 87% (95% CI, 70%-100%). All but 1 patient (due to chemoradiotherapy-related chondroradionecrosis) were decannulated, and 2 required long-term gastrostomy.
  
  
  CONCLUSIONS
  In the absence of a favorable transoral access, the "hybrid" approach of combined transoral and limited pharyngotomy can accomplish margin-negative primary tumor resection, with a high degree of disease control and functional recovery in selected OPSCC patients.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Sinha
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Patrik
authors.initials: P
authors.lastname: Pipkorn
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zenga
authors.affiliation: 2 Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, USA.|3 Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009055:Mouth / Q000601:surgery; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods; D010614:Pharynx / Q000000981:diagnostic imaging / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D014481:United States
keywords: minimally invasive surgical technology; oropharynx cancer; p16 positive; pharyngotomy; transoral laser microsurgery