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Program Number: B223
Session Name: Poster Session

"Close then Clear" Resection Margins in Transoral Resection of p16+ Oropharyngeal Squamous Cell Carcinoma

Kalpesh Hathi, MD¹; Chrisje Den Besten, MD, PhD²; Colin MacKay, MSc¹; Depak Patel, MBBS, FRACS³; Martin J Bullock, MD, FRCSC⁴; Matthew H Rigby, MD, MPH, FRCSC¹; Mark S Taylor, MD, FRCSC¹; Jonathan Trites, MD, FRCSC¹; Martin Corsten, MD, FRCSC¹; ¹Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie, University, Halifax, NS Canada; ²Department of Otolaryngology - Head and Neck Surgery, Haaglanden MC, The Hague, Netherlands; ³Department of Otolaryngology-Head and Neck Surgery, Wellington Hospital, Wellington, New Zealand; ⁴Department of Pathology, Dalhousie University, Halifax, NS, Canada

Background: p16+ oropharyngeal squamous cell carcinoma (SCC) presents favorable patient outcomes. Standard 5 mm surgical margins in the oropharynx are challenging due to its intimate relationship with neurovascular structures and patient function. The impact of close surgical margins on outcomes is uncertain and practice patterns vary. This study assesses two-year locoregional recurrence with initial close (≤ 2 mm) surgical margins following transoral surgery for p16+ oropharyngeal SCC with or without re-resection and adjuvant therapy.

Methods: Retrospective chart review including all patients who underwent transoral robotic surgery (TORS) or transoral laser microsurgery (TLM) with curative intent for p16+ oropharyngeal SCC and had ≤ 2 mm initial surgical margins with or without re-resection and adjuvant therapy between January 2019 and December 2023 at an academic center. Primary outcome was two-year locoregional control.

Results: 80 patients were included, 54 had two-year follow-up available. Initial margins were close (≤ 2 mm) in 44 patients (55%) and positive in 34 patients (42.5%). Re-resection was performed in 67 patients (83.8%). Following re-resections, three patients (3.8%) had positive margins and 77 (96.2%) had close or clear margins. Deep margins were the most commonly involved (67.5%). 42 patients (52.5%) received adjuvant (chemo)-radiotherapy. Amongst the 54 patients eligible for two-year follow-up, one had regional recurrence at 18-months post-surgery, resulting in a two-year locoregional control rate of 98.1%.

Conclusion: p16+ oropharyngeal SCC with close initial surgical margins result in low locoregional recurrence rates. Further prospective evaluation is warranted to better understand de-escalation of therapy within this population.

 

 

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