Surgery for Oropharyngeal Cancer

They may consider using minimally invasive surgery to remove an early oropharyngeal cancer that has not spread outside the oropharynx. This procedure can help spare people from the side effects associated with radiation therapy or chemoradiation.

Open surgery may be performed for more extensive tumors or if oropharyngeal cancer returns after radiation therapy or chemoradiation.

Minimally invasive approaches allow surgeons to avoid incisions on the face or neck when removing oropharyngeal cancer.

Endoscopic Transoral Resection

Endoscopic transoral resection involves removing an oropharyngeal tumor using an endoscope, a thin, lighted tube attached to a video camera. Doctors also use a microscope during surgery for a more detailed view of the anatomy of the area.

During this procedure, the doctor inserts the endoscope through the mouth and into the oropharynx. He or she places a small surgical instrument into the scope to remove the tumor and a margin of healthy tissue, ensuring that all cancer cells are removed. You are given general anesthesia before the surgery.

Transoral Laser Microsurgery

Doctors may use transoral laser microsurgery, which involves placing a laser through an endoscope, to remove an oropharyngeal tumor. This approach can be less damaging to healthy tissue, because it doesn’t require the use of surgical tools, as do other procedures. Doctors use general anesthesia for this procedure.

Transoral Robotic-Assisted Surgery

NYU Langone physicians may use transoral robotic-assisted surgery to remove small tumors in the oropharynx. Robotic-assisted surgery gives surgeons an excellent view of the back of the throat and enhances their ability to perform delicate procedures.

Doctors at NYU Langone’s Robotic Surgery Center use a system that consists of tiny surgical instruments mounted on robotic arms. Another arm contains a camera that creates magnified, high-definition, three-dimensional images on a computer monitor. The images guide the surgeon during the procedure.

The surgical tools and camera are inserted through the mouth and placed in the back of the throat. The surgeon controls the instruments and the camera from a console in the operating room.

Open surgery requires making incisions on the face or neck to remove oropharyngeal cancer. This is done carefully to minimize scarring.

Neck Dissection

During a neck dissection, the surgeon makes one or more incisions in the neck to remove lymph nodes, which are often the first place oropharyngeal cancer spreads. General anesthesia is required.

This surgery may be performed in people who have a minimally invasive transoral procedure to determine whether their lymph nodes contain cancer. This information can help doctors decide whether to give radiation therapy or chemoradiation after surgery.

Surgeons may also perform a neck dissection if radiation therapy or chemoradiation does not shrink cancer in the lymph nodes.

Tumor Removal

If oropharyngeal cancer returns after other treatments, doctors may recommend removing a tumor using open surgery. Doctors use various methods to access the tumor and can discuss the best approach for you. General anesthesia is required for this procedure.

Tracheostomy

Open surgery to remove oropharyngeal cancer may cause swelling in the back of the mouth and throat, which can interfere with breathing. To avoid blocking the airway, doctors may perform a temporary tracheostomy, in which they make an incision on the neck and insert a breathing tube into the trachea, or windpipe, allowing you to breathe. After the swelling subsides, the tube is removed—usually before you leave the hospital.

Reconstruction

If necessary, reconstructive surgeons at NYU Langone can repair parts of the tongue or other parts of the oropharynx that may be removed during open surgery.

Areas of soft tissue can be replaced with a piece of healthy tissue, called a flap, taken from elsewhere in the body. Flaps may come from the scalp, cheek, forehead, neck, or chest.

Often, flap tissue is taken from a distant part of the body. This type of flap is called a microvascular free flap. It allows the surgeon to use tissue from another part of the body that may more closely match the properties of the removed tissue. For example, forearm skin and underlying soft tissue may replace a missing portion of the tongue, so it can be used for speech and swallowing. The flap’s blood vessels are carefully attached to vessels in the oropharynx to restore blood flow.

Recovery time after surgery for oropharyngeal cancer varies. For example, if surgeons use an endoscopic approach for an early cancer, you may be able to go home the same day. If open surgery and reconstruction are needed, the hospital stay may last for up to a week. During this time, doctors closely monitor your health and can prescribe medication to manage any discomfort.