Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

Background: Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy.

Methods: A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included.

Results: The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.

Conclusion: In this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies.

Trial registration number: None/not applicable.