Endoscopic-Assisted Oropharyngectomy for Early Oropharyngeal Cancer in Trismus Patients

Objective: Management of the early-stage oropharyngeal carcinoma in trismus patients underlying with multiple head and neck cancer history is a clinical challenge because minimal invasive surgery such as transoral robotic surgery or transoral laser microsurgery is contraindicated, while open surgery or concurrent chemoradiation (CCRT) wound cause long-term adverse effect. Therefore, we developed a novel endoscopic surgical approach for these patients. Methods: Four patients were enrolled for endoscopic-assisted oropharyngectomy. The oropharyngeal tumor was resected with an adequate margin via a one-surgeon bimanual approach with the aid of a high-resolution videoendoscopic system, scope holder, and designed surgical instruments. The postoperative surgical margin status, trismus status, perioperative complication, average hospital stay, and follow-up period were recorded. Results: The endoscopic-assisted oropharyngectomy was successfully applied in all 4 patients with en bloc tumor excision and adequate free margin status. The mean hospital stay was 6.5 days, and all patients could tolerate oral diet within 2 weeks. There was no perioperative complication noted. No tumor recurrence was identified in patients followed up 2 years after surgery. Conclusion: Endoscopic-assisted oropharyngectomy for patients with trismus and multiple head and neck cancer history is a safe, minimal invasive, and effective treatment choice other than open surgery or CCRT. It provides a safe option for patients with limited mouth opening.