Completion Lateral Oropharyngectomy for Palatine Tonsillar Squamous Cell Carcinoma Previously Managed with Diagnostic Tonsillectomy

Sunday, October 12, 2025

8:06 AM - 8:12 AM EDT

Location: 127

Disclosure(s):

Janice L. Farlow, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pathologic diagnosis of oropharyngeal squamous cell carcinoma (OPSCC) of the palatine tonsil is sometimes made after a diagnostic tonsillectomy has been performed, complicating the decision making of the interdisciplinary care team. Here we describe our experience with transoral robotic surgery (TORS) for management of residual local disease in this patient population by performing completion lateral oropharyngectomy (CLO) after diagnostic tonsillectomy.

Methods: CLO operative technique is reviewed. A single center retrospective review of cases was conducted. Eligible patients underwent TORS from 2012 to 2024 for primary palatine tonsillar SCC. We compared cases requiring CLO after diagnostic tonsillectomy with cases where primary lateral oropharyngectomy was performed.

Results: All 141 included cases were p16(+). Median age was 59 (range 25-86), and most cases were male (87.9%) and white (95%). Of these, 24 (17.0%) underwent CLO while 117 (83.0%) underwent primary lateral oropharyngectomy. All patients undergoing CLO had T1 or T2 disease. Among 22 diagnostic tonsillectomies with pathologic margin assessment, 20 (90.1%) showed positive margins. Despite this, residual SCC was pathologically detected in only 9 (37.5%) patients after CLO. CLO yielded negative final pathologic margins in all cases, with no locoregional recurrences to date. Seventeen (70.8%) CLO patients were observed without adjuvant radiation. Three (12.5%) CLO patients required return to OR for postoperative bleeding compared to 6 (5.1%) after primary lateral oropharyngectomy (Fisher P=0.18).

Conclusions: CLO represents a useful technique for surgically managing OPSCC in patients previously treated with diagnostic tonsillectomy and has an important role in the era of treatment deintensification. Such patients have small primary tumors and would otherwise represent good surgical candidates. Although most diagnostic tonsillectomy specimens show positive pathologic margins, most pathologic CLO specimens show no residual disease. Patients should be counselled appropriately on the risk of postoperative bleeding.

Presenting Author(s)

BW

Benjamin Wahle, MD

Head and Neck Surgery Fellow
Indiana University School of Medicine, Department of Otolaryngology/Head and Neck Surgery
Indianapolis, Indiana, United States

Disclosure information not submitted.

Senior Author(s)

MS

Michael W. Sim, MD

Associate Professor
Indiana University School of Medicine
Zionsville, IN, United States

Disclosure information not submitted.

Co-Author(s)

PR

Peyton Z. Robinson, MD

Resident
University of Louisville
Louisville, KY, United States

Disclosure information not submitted.
PR

Pari Revankar, Other

Student
Indiana University School of Medicine, Department of Otolaryngology/Head and Neck Surgery
fishers, IN, United States

Disclosure information not submitted.
MM

Michael G. Moore, MD

Professor
Indiana University Health
Indianapolis, Indiana, United States

Disclosure information not submitted.
AM

Avinash V. Mantravadi, MD

Associate Professor of Clinical Otolaryngology - Head and Neck Surgery
Indiana University
Indianapolis, IN, United States

Disclosure information not submitted.
Janice L. Farlow, MD, PhD

Assistant Professor
Indiana University
Indianapolis, IN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
DC

David A. Campbell, MD

Assistant Professor
Indiana University School of Medicine
Avon, IN, United States

Disclosure information not submitted.
JY

Jessica A. Yesensky, MD

Assistant Professor of Otolaryngology - Head and Neck Surgery
Indiana University School of Medicine
Indianapolis, Indiana, United States

Disclosure information not submitted.
Deborah X. Xie, MD

Fellow
Indiana University School of Medicine
Phoenix, AZ, United States

Disclosure information not submitted.