Table 3: Utility of tonsillectomy in HNSCCUP cancer unknown origin. IL:
ipsilateral. BL: bilateral. PE: panendoscopy. Ix: Investigation. Ex:
examination. BOT: base of tongue, PT: palentine tonsillectomy, Bx:
biopsy.
Contralateral and synchronous tonsil tumours
There is considerable heterogeneity between papers regarding the
practice of unilateral or bilateral palatine tonsillectomy; variations
on the theme included ipsilateral tonsillectomy only, ipsilateral
tonsillectomy with contralateral tonsil biopsies, and bilateral
tonsillectomy. Nine studies reported synchronous and/or contralateral
cancer identification rates5,12,11,14,19,23-26. Four
small retrospective studies specifically addressed the role of bilateral
palatine tonsillectomy 23-26. Rokkajer et
al23 and Saber et al24 reported
rates of synchronous primaries in tonsil SCC, not solely HNSCCUP.
Di Maio et al’s8 meta-analysis reported rates of 1%
contralateral and 10% bilateral synchronous tonsil primaries. The
synchronous tonsil primary rates amongst these studies varied from
3.3%23 up to 22.7%25.
Contralateral rates ranged from 2%12 to
12.5%26. Saber et al24 found the
majority of bilateral tonsil tumours were in patients with HPV positive
disease (75%).
Given the possibility of contralateral tonsil cancers and rate of
synchronous tonsil primaries there is a case for performing bilateral
tonsillectomy in the workup of HNSCCUP. As a minimum, ipsilateral
tonsillectomy should be performed and bilateral tonsillectomy should be
considered.