To the Editor The article by Zenga et al1 on the role of surgery for T4 oropharyngeal cancer was interesting, but I believe it had several omissions that add to the limitations. The most problematic issue with the analysis was the inherent bias in a comparison between 2 groups, 1 that undergoes the therapy (surgery) and 1 that does not, when the latter group has patients who either medically or technically cannot receive the therapy.
Garden AS. Surgical Treatment for T4 Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg. 2017;143(1):96–97. doi:10.1001/jamaoto.2016.2242
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