经口机器人手术后根治性扁桃体切除标本的切缘分析

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2025-05-30 DOI:10.1016/j.oraloncology.2025.107403

Jane Y. Tong , Kathryn Brimanson , Kelly Moyer , Jeffrey Wolf , Rodney Taylor , Michael Kallen , Hector Mesa , Kyle M. Hatten

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引用次数: 0

摘要

目的经口机器人手术（TORS）治疗腭扁桃体鳞状细胞癌（SCC）患者的切缘充分性在实践中仍然存在争议和差异。我们描述根治性扁桃体切除术后的边缘分析，包括肌肉侵犯和手术中断。方法回顾性分析2017年1月至2023年12月接受TORS根治性扁桃体切除术的患者。检查病理报告是否有阳性、接近（2mm）或清晰的边缘。对载片进行评估，以确定咽收缩肌可能的医源性破坏，定义为肌肉纤维分离，伴有烧灼痕迹和边缘墨水渗出的证据，以及肌肉侵犯，分为缺失、部分（肌肉内）或完全（肌肉外）。结果66例腭扁桃体鳞状细胞癌患者行TORS根治性扁桃体切除术。男性57例（86.4%）。平均年龄59.7岁。pT1 31例（47.0%），pT2 32例（48.5%），pT3 3例（4.5%）。36例（54.5%）显示接近，26例（39.4%）显示清晰，4例（6.1%）显示阳性。所有人都表现出肌肉断裂。27例（40.9%）无肌侵犯，32例（48.5%）部分肌侵犯，7例（10.6%）完全肌侵犯。边缘状态与肌肉侵犯无显著相关。肌肉侵袭与T分期（p = 0.049）、受累淋巴结数（p = 0.043）和辅助治疗（p = 0.016）相关。切缘状态与PNI显著相关(p <；0.001)。结论在根治性扁桃体切除术中，外科肌肉损伤是普遍存在的。肌肉侵犯（59.1%）和切缘紧密（54.5%）也很常见。肌肉侵袭与T分期、受累淋巴结数量和辅助治疗有关，但与边缘状态无关，尽管这需要进一步研究。对于腭扁桃体恶性肿瘤，传统定义≥5mm的清晰边缘在解剖学上可能不可行。

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Margin analysis of radical tonsillectomy specimens following transoral robotic surgery

Objectives

Interpretation of margin adequacy in patients with squamous cell carcinoma (SCC) of the palatine tonsil treated with transoral robotic surgery (TORS) remains controversial and variable in practice. We describe margin analysis after radical tonsillectomy, including muscle invasion and surgical disruption.

Methods

Patients undergoing TORS radical tonsillectomy between January 2017 to December 2023 were retrospectively reviewed. Pathology reports were reviewed for positive, close (<2 mm), or clear margins. Slides were evaluated for likely iatrogenic disruption of the pharyngeal constrictor, defined as the separation of muscle fibers with cautery artifact and evidence of margin ink seepage, as well as for muscle invasion, stratified as absent, partial (within muscle) or complete (beyond muscle).

Results

Sixty-six patients with SCC of the palatine tonsil underwent TORS radical tonsillectomy. Fifty-seven (86.4 %) were male. Mean age was 59.7 years. Thirty-one (47.0 %) were pT1, 32 (48.5 %) pT2, and three (4.5 %) pT3. Thirty-six (54.5 %) demonstrated close, 26 (39.4 %) clear, and four (6.1 %) positive margins. All demonstrated muscle disruption. Twenty-seven (40.9 %) demonstrated no muscle invasion, 32 (48.5 %) partial, and seven (10.6 %) complete invasion. Margin status was not significantly associated with muscle invasion. Muscle invasion was associated with T stage (p = 0.049), number of involved lymph nodes (p = 0.043), and adjuvant treatment (p = 0.016). Margin status was significantly associated with PNI (p < 0.001).

Conclusions

Surgical muscle disruption was universal during radical tonsillectomy. Muscle invasion (59.1 %) and close margins (54.5 %) also were common. Muscle invasion was associated with T stage, number of involved lymph nodes, and adjuvant treatment, but not margin status, although this requires further study. Clear margins traditionally defined as ≥ 5 mm may not be anatomically feasible for palatine tonsil malignancies.

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.