TRANSORAL LASER RESECTION WITH STAGED DISCONTINUOUS NECK DISSECTION FOR ORAL CAVITY AND OROPHARYNX SQUAMOUS-CELL CARCINOMA

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cerv ical lymph node metastases. This study investigated the results of tra nsoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hun dred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty -nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4 . Lymph node metastases were identified in the ND specimen of 36 patie nts. All patients were followed for a minimum of 3 years unless they d ied. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease o f the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 7 2 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of dist ant metastases with no evidence of local or regional recurrence. The c ombination of transoral laser resection and staged ND for the treatmen t of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbid ity than commando-type surgery and lead to low perioperative mortality and morbidity.