{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T12:25:31Z","timestamp":1788265531975,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Despite epidemiologic evidence that second primaries occur infrequently in HPV (human papillomavirus)\u2013associated oropharyngeal squamous cell carcinoma, recent recommendations advocate for elective contralateral palatine tonsillectomy. We aimed to study this discordance and define the necessary extent of up\u2010front surgery in a large contemporary cohort with long\u2010term follow\u2010up treated with unilateral transoral robotic surgery. We hypothesized that second primaries are discovered exceedingly rarely during follow\u2010up and that survival outcomes are not compromised with a unilateral surgical approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care academic center between 2007 and 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Records for patients with p16\u2010positive oropharyngeal squamous cell carcinoma of the tonsil and workup suggestive of unilateral disease who underwent ipsilateral transoral robotic surgery were analyzed for timing and distribution of locoregional recurrence, distant metastases, and second primary occurrence as well as survival characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 295\u00a0included patients, 21 (7.1%) had a locoregional recurrence; 17 (5.8%) had a distant recurrence; and 3 (1.0%) had a second primary during a median follow\u2010up of 48.0\u00a0months (interquartile range, 29.5\u201062.0). Only 1 (0.3%) had a second primary found in the contralateral tonsil. The 2\u2010 and 5\u2010year estimates of overall survival were 95.5% (SE, 1.2%) and 90.1% (SE, 2.2%), respectively, while the 2\u2010 and 5\u2010year estimates of disease\u2010free survival were 90.0% (SE, 1.8%) and 84.7% (SE, 2.3%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Second primary occurrence in the contralateral tonsil was infrequent, and survival outcomes were encouraging with unilateral surgery. This provides a rationale for not routinely performing elective contralateral tonsillectomy in patients whose workup suggests unilateral disease.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599820968800","type":"journal-article","created":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T04:00:57Z","timestamp":1604376057000},"page":"1222-1229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Revisiting the Recommendation for Contralateral Tonsillectomy in HPV\u2010Associated Tonsillar Carcinoma"],"prefix":"10.1002","volume":"164","author":[{"given":"Harman S.","family":"Parhar","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Shimunov","sequence":"additional","affiliation":[{"name":"Department of 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