Transoral robotic surgery for tonsillar cancer: Addressing the contralateral tonsil

Abstract

BACKGROUND: The purpose of this study is to determine the incidence and risk factors for bilateral tonsillar cancers treated with transoral robotic surgery (TORS) and to determine the morbidity of the procedure. METHODS: Patients undergoing TORS for known tonsillar cancer were retrospectively reviewed. Perioperative variables and surgical outcomes were analyzed to determine predictive factors for bilateral disease and morbidity rates. RESULTS: Seventy-nine consecutive patients with tonsillar cancers underwent primary TORS radical tonsillectomy. Thirty of these patients also underwent contralateral tonsillectomy. Three patients (10%) were found to have contralateral tonsillar cancers on final pathology. These were not identified on preoperative positron emission tomography (PET)-CT or clinical examination. There were no differences in complications, gastrostomy tube (G-tube) rates, or length of stay (P > .05). Blood loss was 11.5 cc more in the contralateral tonsillectomy group (P = .001). CONCLUSION: All patients undergoing primary TORS for tonsillar cancers should also undergo contralateral tonsillectomy to optimize oncologic outcomes with no increase in morbidity.