Submandibular gland preservation during concurrent neck dissection and transoral surgery for oropharyngeal squamous cell carcinoma.
OBJECTIVES
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.


STUDY DESIGN
Retrospective chart review of prospectively collected data.


SETTING
Tertiary academic referral center.


METHODS AND SUBJECTS
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.
['Howard|Brittany E|BE|', 'Hinni|Michael L|ML|', 'Nagel|Thomas H|TH|', 'Chang|Yu-Hui|YH|', 'Cheng|Meng-Ru|MR|', 'Hayden|Richard E|RE|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002294:Carcinoma, Squamous Cell D015331:Cohort Studies D018572:Disease-Free Survival D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D009055:Mouth D037981:Neck Dissection D009926:Organ Preservation D059351:Organ Sparing Treatments D009959:Oropharyngeal Neoplasms D061214:Patient Safety D012189:Retrospective Studies D018570:Risk Assessment D013363:Submandibular Gland D016019:Survival Analysis D016896:Treatment Outcome
submandibular gland transoral surgery squamous cell carcinoma laser disease free survival disease specific survival overall survival head and neck cancer oropharyngeal neoplasms robotics squamous cell neoplasms transoral laser microsurgery transoral robotic surgery