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Radical Tonsillectomy

Gregory S. Weinstein, MD; Bert W. O’Malley Jr, MD; Wendy Snyder, BS; Eric Sherman, MD; Harry Quon, MD, MS

Arch Otolaryngol Head Neck Surg. 2007;133(12):1220-1226.

Objective  To describe and show the feasibility of a new surgical technique for transoral robotic surgery (TORS) radical tonsillectomy.

Design  A prospective, phase 1 clinical trial.

Setting  Academic, tertiary referral center.

Patients  A total of 27 participants were prospectively selected using a volunteer sample. All eligible patients agreed to participate in the study.

Interventions  Patients underwent TORS radical tonsillectomy for previously untreated invasive squamous cell carcinoma of the tonsillar region without free-flap reconstruction, staged neck dissection, and adjuvant therapy.

Main Outcome Measures  Outcome measures included final pathologic margin status, need for short- and long-term tracheotomy tube placement, and need for gastrostomy tube feedings among patients with a minimum 6-month follow-up. The incidence of significant postoperative complications was recorded.

Results  No mortality occurred. Final margins found to be negative for cancer were achieved in 25 of 27 patients (93%). Surgical complications included 1 case each of postoperative mucosal bleeding, delirium tremens, unplanned tracheotomy for temporary exacerbation of sleep apnea, and hypernasality and 2 cases of moderate trismus. Twenty-six of 27 patients (96%) were swallowing without the use of a gastrostomy.

Conclusions  Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity. Future reports will focus on long-term oncologic and functional outcomes.

Author Affiliations: Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Weinstein, O’Malley, and Quon and Ms Snyder), Medicine, Division of Hematology and Medical Oncology (Dr Sherman), and Radiation Oncology (Dr Quon), University of Pennsylvania, Philadelphia.

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