A meta-analysis of 11 studies including 1,486 patients found that unilateral transoral surgery for tonsillar squamous cell carcinoma was associated with negligible contralateral tumor risk and survival outcomes comparable with bilateral procedures.
Of the patients studied, 634 underwent bilateral surgery and 852 underwent unilateral procedures. The rate of contralateral tumors developing following unilateral surgery was 0.1%, while synchronous tumors identified during bilateral surgery occurred in 4% of patients.
Survival outcomes were similar. Two-year overall survival was 94% in bilateral cases and 96% in unilateral cases. At five years, overall survival was 78% compared with 84%. Disease-free survival was also comparable, with 2-year rates of 93% for unilateral surgery and 92% for bilateral surgery. At 5 years, disease-free survival was 85% in unilateral cases and 74% in bilateral cases.
Complication rates showed no meaningful differences. Oropharyngeal hemorrhage occurred in about 6% of patients in both groups. Long-term dependence on gastrostomy tubes was reported in 5% of bilateral patients and 4% of unilateral patients. One study assessed swallowing outcomes and found no difference in the time to removal of nasogastric feeding tubes between the two groups.
The review included adults with unilateral tonsillar squamous cell carcinoma treated with transoral surgery and reporting outcomes such as tumor occurrence, survival, hemorrhage, or swallowing complications. Literature searches of Embase, MEDLINE, Scopus, and Cochrane databases were conducted through September 2024.
Median follow-up ranged from 11 to 50 months. Among studies reporting human papillomavirus (HPV) status, 92.6% of patients were positive. Sensitivity analyses confirmed that the low rate of contralateral tumors following unilateral surgery remained consistent in studies with at least 24 months of follow-up and those with at least 48 months of follow-up.
While bilateral procedures occasionally uncovered synchronous tumors, the likelihood of a new contralateral tumor developing after unilateral surgery was very low. For most patients with unilateral tonsillar squamous cell carcinoma, particularly those with HPV-positive disease, limiting surgery to the affected side did not compromise oncologic or functional outcomes.
The study had limitations. All included studies were retrospective, which introduced potential bias and limited causal conclusions. Reporting of secondary outcomes, such as swallowing complications, was inconsistent. Two of the 11 studies were available only as abstracts, though their data were included due to sufficient detail. Subgroup analyses separating HPV-positive and HPV-negative patients were not possible because of incomplete reporting.
The researchers concluded that unilateral transoral surgery for unilateral tonsillar squamous cell carcinoma was associated with very low contralateral tumor risk and survival outcomes comparable with bilateral procedures. Surgical approach decisions should be made within multidisciplinary planning and patient-specific considerations.
Disclosures can be found in the published study.