Unilateral vs Bilateral Transoral Surgery for Tonsillar Squamous Cell Carcinoma

Among patients with tonsillar squamous cell carcinoma (SCCa), what are the second primary tumor rates, oncologic survival, functional outcomes, and complications between patients undergoing bilateral vs unilateral transoral surgery?This systematic review and meta-analysis of 11 studies including 1486 patients found that the synchronous contralateral tonsil second primary rate for patients undergoing bilateral surgery was 4% (95% CI, 2%-5%) and that the metachronous contralateral tonsil second primary rate for patients undergoing unilateral surgery was 0.1% (95% CI, 0%-1%). There were no differences in overall survival, disease-free survival, gastrostomy tube dependence, and postoperative oropharyngeal hemorrhage rates.This study suggests that omission of contralateral elective extracapsular tonsillectomy in tonsillar SCCa is safe; there are no clear benefits to performing bilateral surgery for unilateral tonsillar SCCa.

Corresponding Author: Andrew M. Peterson, MD, MSCI, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8115, St Louis, MO 63110 (pandrew@wustl.edu).

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