口咽鳞状细胞癌中的对侧扁桃体切除术：诊断收益与操作负担

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中文摘要

目的： 针对侧别明确的单侧口咽鳞状细胞癌的放疗可降低治疗毒性。本研究评估为寻找同步扁桃体恶性肿瘤而常规实施对侧扁桃体切除术是否合理。
方法： 对一家三级中心（2022-2024年）以治愈为目的治疗的81例口咽鳞状细胞癌患者进行回顾性分析。所有患者均接受正电子发射断层扫描计算机断层扫描。对单侧放疗候选者实施对侧扁桃体切除术。
结果： 42例患者接受了对侧扁桃体切除术。1例患者（2.4%）发现同步对侧鳞状细胞癌，因颈清扫发现结外扩展而需要双侧颈部放化疗。11例患者（26%）在中位间隔21天后接受了分期手术。1例患者（2.4%）发生需要再次住院的扁桃体切除术后出血。
结论： 常规对侧扁桃体切除术未产生任何改变患者治疗侧别的发现。这提示省略对侧扁桃体切除术可能补充降阶梯策略。

英文摘要

OBJECTIVE: Unilateral radiotherapy for well-lateralised oropharyngeal squamous cell carcinoma reduces treatment toxicity. This study evaluated whether routine contralateral tonsillectomy, performed to look for synchronous tonsillar malignancies, is justified.
METHODS: A retrospective analysis was conducted of 81 patients treated with curative intent for oropharyngeal squamous cell carcinoma at a tertiary centre (2022-2024). All patients underwent positron emission tomography computed tomography. Contralateral tonsillectomy was performed in candidates for unilateral radiotherapy.
RESULTS: Forty-two patients underwent contralateral tonsillectomy. Synchronous contralateral squamous cell carcinoma was identified in one patient (2.4 per cent) who required bilateral cervical chemoradiation because of extranodal extension found on neck dissection. Eleven patients (26 per cent) underwent staged procedures after a median interval of 21 days. Post-tonsillectomy haemorrhage requiring hospital re-admission occurred in one patient (2.4 per cent).
CONCLUSION: Routine contralateral tonsillectomy did not yield any findings that altered the laterality of treatment in any patient. This suggests that omitting contralateral tonsillectomy may complement de-escalation strategies.