1. Surgical Management of Oropharyngeal Cancers Kerry D. Olsen, M.D. Professor, Otolaryngology Head and Neck Surgery Mayo Clinic Kerry D. Olsen, M.D. Professor, Otolaryngology Head and Neck Surgery Mayo Clinic Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

2. Advanced Oropharyngeal Cancer  Organ preservation philosophy: Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008 What is the functional benefit of preserving the tonsil or half of the tongue base?

3. The National Cancer Data Base Report on Squamous Cell Carcinoma of the Base of Tongue Head and Neck May 2004  Largest contemporary overview of presentation cure and outcome for base of tongue SCC  16,188 cases75%Stage 3, 4 (1985-1996)  Treatment%Patients Surgery16 2,561 Radiation24 3,972 Surgery + Rad27 4,354 Rad + Chemo14 2,342 Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

4.  Outcome: Early stage 1, 2 disease 5-year Disease Specific Survival Surgery75% Radiation46% Rad + Chemo29% Advanced stage 3, 4 disease 5-year Disease Specific Survival Surgery + Rad51% Surgery42% Rad + Chemo26% Rad24% Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

5. Tongue Base Squamous Cell Carcinoma  219 patients – advanced stage 3, 4 All completed treatment Disease specific survival 5 yr Surgery 83% Surgery/RT 60% Chemo/RT 23% Kowalski, L. M.D.  219 patients – advanced stage 3, 4 All completed treatment Disease specific survival 5 yr Surgery 83% Surgery/RT 60% Chemo/RT 23% Kowalski, L. M.D. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

6. Oropharyngeal Cancer  Prevailing opinion: Surgery Difficult to approach Extensive time commitment Poor reimbursement Won’t eat Leak Send for alternative therapy Reality Good function in vast majority Short hospitalization Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

7. Oropharyngeal Cancer Surgical Management  In reality, most cases: Don’t exhibit bone invasion (mandible) Don’t involve the larynx to a significant degree Spare one or both hypoglossal nerves Don’t involve majority of the soft palate Don’t involve carotid artery, para- pharyngeal space/pre-vertebral fascia Are accessible surgically Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

8. 102 Patients Tonsil Cancer Transoral Excision  Mayo Clinic1996 – 2004  84%Stage 3, 4  25% S70% S+R5% S+R+C  5 yrL – R – D free recurrence 92% - 97% - 91%  Overall survival: 2 yr92% 5 yr85% Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

9. Surgical Management Oropharyngeal Cancer  No functional benefit to preserve tonsil or ½ tongue base  National Cancer Data Base 2004 S 2,561 pts R 3,972 pts S+R 4,354 pts R+C 2,342 pts Stage 1, 2 S 75% R 40% R+C 29% Stage 3, 4 S+R 51% S 42% R+C 26% R 24% Five year disease specific survival  Stage 3, 4 tongue base cancer – 219 patients by Kowalski Disease specific survival 5 yr S 83% S+R 60% R+C 23%  Tonsil Cancer – 102 patients Mayo Clinic 84% Stage 3, 4 5 yr L – R – D free recurrence 92% - 97% - 91% Overall survival2 yr 92% 5 yr 85% Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

10. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008

11. Surgical Management of Oropharyngeal Cancers Frankfurt – January 2008