151
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Siddiq S, Cartlidge D, Stephen S, Sathasivam HP, Fox H, O'Hara J, Meikle D, Iqbal MS, Kelly CG, Robinson M, Paleri V. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with high risk human papillomavirus related squamous cell cancer. Eur Arch Otorhinolaryngol 2018; 275:1853-1860. [PMID: 29754260 DOI: 10.1007/s00405-018-4968-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/06/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. METHODS 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). RESULTS Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4). CONCLUSIONS This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.
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Affiliation(s)
- Somiah Siddiq
- Head and Neck unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - David Cartlidge
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Sarah Stephen
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Hans P Sathasivam
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Hannah Fox
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - James O'Hara
- Otolaryngology, Head and Neck Surgery, Newcastle upon Tyne Hospitals and Newcastle University, Newcastle upon Tyne, NE7 7DN, UK
| | - David Meikle
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Charles G Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
- The Institute of Cancer Research, London, UK.
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152
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Validation and assessment of discordance of the 8th edition AJCC (American Joint Committee on Cancer) clinical and pathologic staging systems in patients with p16+ oropharyngeal cancer treated with surgery and adjuvant radiation at a single institution. Oral Oncol 2018; 83:140-146. [PMID: 30098770 DOI: 10.1016/j.oraloncology.2018.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/27/2023]
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153
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Morisod B, Guinchard AC, Gorphe P, Schweizer V, Sandu K, Simon C. Transoral robotic-assisted supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Procedure development and outcomes of initial cases. Head Neck 2018; 40:2254-2262. [DOI: 10.1002/hed.25332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/14/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Benoît Morisod
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Anne-Claude Guinchard
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Philippe Gorphe
- Department of Head and Neck Oncology; Institute Gustave Roussy; Villejuif France
| | - Valerie Schweizer
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Kishore Sandu
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
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154
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Initiating a Robotic Thyroidectomy Program in India. Indian J Surg Oncol 2018; 9:241-246. [PMID: 29887708 DOI: 10.1007/s13193-018-0746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022] Open
Abstract
Robotic surgery has been successfully used for many surgical indications in head and neck surgery. Robotic thyroidectomy is getting accepted worldwide, but the majority of the literature is from South Korea. The purpose of the paper is to review and give a personal perspective on how a robotic thyroidectomy program was initiated in a tertiary care academic medical institution in India. Advantages of robotic approaches are the three-dimensional visualization, precision, dexterity, and surgeon ergonomics. Cost is an important concern. Training includes basic robotics skill training, cadaveric training, observership, and hands-on training. Sufficient preclinical and clinical training is essential before embarking onto the newer surgical modality. Surgeon credentialing, though institution dependent, has specific guidelines. Case selection is the key, especially in the initial learning curve. The authors prefer the retroauricular approach for robotic thyroidectomy, and our initial experience in the first ten cases of total thyroidectomy was encouraging.
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155
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Abstract
How trans-oral robotic surgery can treat cancer in the oropharyngyal space
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Affiliation(s)
- F Borumandi
- Western Sussex Hospitals NHS Foundation Trust
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156
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Baskin RM, Boyce BJ, Amdur R, Mendenhall WM, Hitchcock K, Silver N, Dziegielewski PT. Transoral robotic surgery for oropharyngeal cancer: patient selection and special considerations. Cancer Manag Res 2018; 10:839-846. [PMID: 29719420 PMCID: PMC5916264 DOI: 10.2147/cmar.s118891] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) emphasizes the importance of optimizing treatment for the disease. Historical protocol has utilized definitive radiation and invasive open procedures; these techniques expose the patient to significant risks and morbidity. Transoral robotic surgery (TORS) has emerged as a therapeutic modality with promise. Here, the literature regarding proper patient selection and other considerations for this procedure was reviewed. Multiple patient and tumor-related factors were found to be relevant for successful use of this treatment strategy. Outcomes regarding early and advanced-stage OPSCC were analyzed. Finally, the literature regarding use of TORS in three distinct patient populations, individuals with primary OPSCC, carcinoma of unknown primary and those with recurrent OPSCC, was examined.
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Affiliation(s)
- R Michael Baskin
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Robert Amdur
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - William M Mendenhall
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Kathryn Hitchcock
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Natalie Silver
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
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157
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Abstract
Neoplasms of the head and neck constitute a broad spectrum of benign and malignant entities. When treatment involves resection, assessment of the surgical margins represents an important component of the pathologic examination. Margin status is an important indicator of a complete surgical resection. The ability to generalize conclusions such as 'safe distance' measurements from work performed mSCCa or cutaneous malignancy to other types of neoplasms in the head and neck region seems limited. This article reviews conditions and considerations for reliable margin assessment and interpretation.
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158
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Sim FW, Xiao HD, Bell RB. Margin Analysis: Squamous Cell Carcinoma of the Oropharynx. Oral Maxillofac Surg Clin North Am 2018; 29:269-280. [PMID: 28709530 DOI: 10.1016/j.coms.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of the common shared risk factors of smoking and heavy alcohol consumption, literature involving oropharyngeal squamous cell carcinoma (OPSCC) is often combined with oral squamous cell carcinoma. Human papilloma virus is now confirmed to be a major risk factor of OPSCC with its distinct epidemiology and favorable treatment outcome. The impact of adjuvant chemoradiation in the setting of positive surgical margins remains unclear but is likely influenced by tumor biology. This article reviews the tumor biology of OPSCC and summarizes recent findings on outcomes following surgical treatment of OPSCC.
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Affiliation(s)
- Felix W Sim
- Head and Neck Institute, Providence Cancer Center, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA
| | - Hong D Xiao
- Head and Neck Pathologist, Department of Pathology, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA
| | - R Bryan Bell
- Head and Neck Institute, Providence Cancer Center, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA.
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159
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Hay A, Migliacci J, Karassawa Zanoni D, Boyle JO, Singh B, Wong RJ, Patel SG, Ganly I. Haemorrhage following transoral robotic surgery. Clin Otolaryngol 2018; 43:638-644. [PMID: 29194991 PMCID: PMC5851834 DOI: 10.1111/coa.13041] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND To report our experience of postoperative haemorrhage in patients following transoral robotic surgery (TORS). METHODS Data were collected on patients having TORS. Postoperative haemorrhage within 30 days was graded using the Mayo Clinic grading system. RESULTS Transoral robotic surgery operations were performed on 122 patients. There were 23 bleeding events classified as minor to severe following 19 operations (16%). Haemorrhage requiring a return to the operating room occurred after 7 operations (6%). The odds of an emergent haemorrhage were 5.19 times greater in patients who had a staged neck dissection after TORS (P = .05). The odds of a postoperative bleeding event were 2.6 times greater in patients receiving a larger resection (P = .107). There were no haemorrhage events in the 36 patients who received a synchronous neck dissection with transcervical ligation of the external carotid artery. CONCLUSIONS Surgical intervention for TORS haemorrhage occurred in 6% patients. No haemorrhage occurred in patients who had ligation of the external carotid artery.
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Affiliation(s)
- A Hay
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Migliacci
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D Karassawa Zanoni
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J O Boyle
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B Singh
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - I Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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160
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Gorphe P, Auperin A, Honart JF, Ton Van J, El Bedoui S, Bidault F, Temam S, Kolb F, Qassemyar Q. Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer. Laryngoscope Investig Otolaryngol 2018; 3:121-126. [PMID: 29721545 PMCID: PMC5915826 DOI: 10.1002/lio2.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/05/2018] [Accepted: 03/01/2018] [Indexed: 12/25/2022] Open
Abstract
Objective We analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical‐transoral robotic oropharyngectomy course with free flap reconstruction. Methods Patients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre‐operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery. Results Three patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous‐cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications. Conclusions In our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations. Level of evidence 4.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Anne Auperin
- Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean Ton Van
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - François Bidault
- Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Stéphane Temam
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Frédéric Kolb
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Quentin Qassemyar
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
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161
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Motz K, Herbert RJ, Fakhry C, Quon H, Kang H, Kiess AP, Eisele DW, Koch WM, Frick KD, Gourin CG. Short- and long-term outcomes of oropharyngeal cancer care in the elderly. Laryngoscope 2018; 128:2084-2093. [DOI: 10.1002/lary.27153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/04/2017] [Accepted: 01/31/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Kevin Motz
- Department of Otolaryngology-Head and Neck Surgery; Baltimore Maryland U.S.A
| | - Robert J. Herbert
- Department of Health Policy and Management; the Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery; Baltimore Maryland U.S.A
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins University; Baltimore Maryland U.S.A
| | - Hyunseok Kang
- Department of Oncology; Sidney Kimmel Comprehensive Cancer Center; Baltimore Maryland U.S.A
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins University; Baltimore Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Baltimore Maryland U.S.A
| | - Wayne M. Koch
- Department of Otolaryngology-Head and Neck Surgery; Baltimore Maryland U.S.A
| | - Kevin D. Frick
- Department of Health Policy and Management; the Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
- Johns Hopkins Carey Business School; Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Baltimore Maryland U.S.A
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162
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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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163
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Nasopharynx access by minimally invasive transoral robotic surgery: anatomical study. J Robot Surg 2018; 12:687-692. [DOI: 10.1007/s11701-018-0804-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
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164
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Paleri V, Fox H, Coward S, Ragbir M, McQueen A, Ahmed O, Meikle D, Saleh D, O'Hara J, Robinson M. Transoral robotic surgery for residual and recurrent oropharyngeal cancers: Exploratory study of surgical innovation using the IDEAL framework for early-phase surgical studies. Head Neck 2018; 40:512-525. [PMID: 29244229 DOI: 10.1002/hed.25032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/10/2017] [Accepted: 10/25/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the role of transoral robotic surgery (TORS) in the management of residual and recurrent oropharyngeal cancer. METHODS IDEAL (Idea, Development, Exploration, Assessment, Long-term Follow-up) 2a framework. RESULTS Of 26 patients assessed for TORS, 21 underwent the procedure, 5 underwent open resection (4 due to unsuitable anatomy/tumor extent and 1 on the basis of patient choice). Three patients underwent intraoperative ultrasound-assisted robotic resection, and 3 received robotic-assisted free flap inset. A technical refinement for TORS of residual and recurrent oropharyngeal cancer of the tongue base is described. Actuarial plots showed estimated overall survival of 48.2%, local control of 76.6%, and disease-specific survival of 77.1% at 42.6 months. CONCLUSION TORS is a valid management option for residual and recurrent oropharyngeal cancer. Oncologic outcomes are comparable to open surgery and transoral laser microsurgery, with the added advantages of en bloc resections, facility for intraoperative ultrasound imaging, and inset of free flaps without mandibular split.
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Affiliation(s)
- Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Hannah Fox
- Department of Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Sarah Coward
- Department of Speech and Language Therapy, Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Maniram Ragbir
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Andrew McQueen
- Department of Radiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Omar Ahmed
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - David Meikle
- Department of Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Daniel Saleh
- Department of Plastic and Reconstructive Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - James O'Hara
- Department of Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Max Robinson
- Department of Pathology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
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165
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166
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Ho AS, Maghami E. Surgical Perspectives in Head and Neck Cancer. Cancer Treat Res 2018; 174:103-122. [PMID: 29435839 DOI: 10.1007/978-3-319-65421-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Head and neck cancer treatment is a complex multidisciplinary undertaking. Cancer cure and survival is a primary goal, yet safe-guarding appearance and function to preserve the quality of life are similarly critical. The head and neck surgeon remains central to multidisciplinary cancer care, with deep knowledge of operative technique and an even deeper understanding of cancer biology. The surgeon models practice based on the highest levels of scientific evidence, but also takes into consideration the approaches that may best suit an individual patient. The surgeon's role moreover spans the life history of a head and neck cancer patient, from diagnosis to surveillance. The intimacy of this role makes the surgeon a trusted and frequent frame of reference for the patient. In this chapter, we provide an overview of the surgeon's role in head and neck cancer management. We discuss surgical perspectives within the multidisciplinary care team and selectively highlight some of the more provocative clinical scenarios in the field.
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Affiliation(s)
- Allen S Ho
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ellie Maghami
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, USA.
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167
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Mahmoud O, Sung K, Civantos FJ, Thomas GR, Samuels MA. Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus. Head Neck 2017; 40:710-721. [DOI: 10.1002/hed.25036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/21/2017] [Accepted: 10/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar Mahmoud
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, Cancer Institute of New Jersey; New Brunswick New Jersey
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, New Jersey Medical School; Newark New Jersey
| | - Kim Sung
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, Cancer Institute of New Jersey; New Brunswick New Jersey
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, New Jersey Medical School; Newark New Jersey
| | - Francisco J. Civantos
- Department of Otolaryngology - Head and Neck Surgery; University of Miami-Miller School of Medicine; Miami Florida
| | - Giovanna R. Thomas
- Department of Otolaryngology - Head and Neck Surgery; University of Miami-Miller School of Medicine; Miami Florida
| | - Michael A. Samuels
- Department of Radiation Oncology; University of Miami-Miller School of Medicine; Miami Florida
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168
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Persky MJ, Albergotti WG, Rath TJ, Kubik MW, Abberbock S, Geltzeiler M, Kim S, Duvvuri U, Ferris RL. Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 158:660-666. [PMID: 29182490 DOI: 10.1177/0194599817742852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P = .004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P = .002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P = .02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
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Affiliation(s)
- Michael J Persky
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - William G Albergotti
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanya J Rath
- 3 Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Kubik
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shira Abberbock
- 4 Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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169
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Spellman J, Sload R, Kim P, Martin P, Calzada G. Staging Neck Dissection and Transoral Robotic Surgery Treatment Algorithm in Palatine Tonsil Cancer. Otolaryngol Head Neck Surg 2017; 158:479-483. [DOI: 10.1177/0194599817742615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This study introduces a treatment algorithm based on staging neck dissection to identify patients with palatine tonsil squamous cell carcinoma who can be effectively treated with single-modality transoral robotic surgery while maintaining quality of life. Study Design Retrospective case series. Setting Kaiser Permanente Southern California Medical Group from 2012 to 2017. Subjects and Methods Patients with early-stage (T1/2) palatine tonsil squamous cell carcinoma with clinically and radiographically N0 necks underwent staging neck dissection. Those with pN2/3 disease or extracapsular extension on final pathology were triaged to definitive chemoradiation treatment. Patients with confirmed pN0/1 necks without extracapsular extension were treated definitively with transoral robotic surgery. Results Nineteen patients with cN0 disease underwent selective neck dissection. All were p16 positive. Of these, 14 had pathologically confirmed N0/1 necks without extracapsular extension and were treated with primary surgical resection via transoral robotic surgery. Clear margins were obtained on all patients. There were no significant intra- or postoperative complications. No patients required gastrostomy tube or tracheostomy placement. Mean and median follow-up was 28 months with no recurrences to date. Conclusion Up-front staging neck dissection accurately triages low-risk patients, determining candidates for single-modality definitive treatment with transoral robotic surgery. This approach provides excellent survival outcomes and minimal morbidity and maintains quality of life among appropriately selected patients with palatine tonsil cancer.
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Affiliation(s)
- Joseph Spellman
- Department Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Ryan Sload
- Department Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Paul Kim
- Department of Head and Neck Surgery, Kaiser Permanente Southern California Medical Group, Fontana, California, USA
| | - Peter Martin
- Department of Head and Neck Surgery, Kaiser Permanente Southern California Medical Group, San Diego, California, USA
| | - Gabriel Calzada
- Department of Head and Neck Surgery, Kaiser Permanente Southern California Medical Group, San Diego, California, USA
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170
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Tateya I, Koh YW, Tsang RK, Hong SS, Uozumi R, Kishimoto Y, Sugimoto T, Holsinger FC. Flexible next-generation robotic surgical system for transoral endoscopic hypopharyngectomy: A comparative preclinical study. Head Neck 2017; 40:16-23. [PMID: 29130568 DOI: 10.1002/hed.24868] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/28/2017] [Accepted: 05/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this cadaveric study was to determine the efficacy of a flexible, next-generation robotic surgical system for transoral robotic hypopharyngectomy. METHODS A comparative evaluation study of the flexible versus rigid robotic surgical systems for the hypopharynx was conducted using 3 cadavers. Endpoints for assessment were visualization of the hypopharynx, access to the hypopharynx, and difficulty of dissection. Hypopharyngectomy was performed on 3 other cadavers using the da Vinci Sp surgical system. RESULTS Access to the apex of the pyriform sinus and the esophageal inlet was easier with the da Vinci Sp than with the da Vinci Si. Dissection with the da Vinci Sp was easier in all areas of the hypopharynx than with the da Vinci Si. Robotic hypopharyngectomy was successfully completed on all cadavers using the da Vinci Sp surgical system. CONCLUSION Preclinical testing in human cadavers suggests that flexible robotic surgery may facilitate successful transoral hypopharyngectomy.
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Affiliation(s)
- Ichiro Tateya
- Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Raymond K Tsang
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgery, University of Hong Kong, Hong Kong
| | - Steven S Hong
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taro Sugimoto
- Department of Otolaryngology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California
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171
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Jackson RS, Sinha P, Zenga J, Kallogjeri D, Suko J, Martin E, Moore EJ, Haughey BH. Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy. Ann Surg Oncol 2017; 24:3494-3501. [PMID: 28808988 PMCID: PMC9012985 DOI: 10.1245/s10434-017-6041-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 12/04/2023]
Abstract
BACKGROUND With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma. METHODS A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4). RESULTS The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1-102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01-0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02-0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02-2.57) or overall survival (HR 0.18; 95% CI 0.01-2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6-20.6). CONCLUSIONS Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.
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Affiliation(s)
- Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA.
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
- Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Jasmina Suko
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
- Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Eliot Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce H Haughey
- Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health and Florida Hospital Cancer Institute, Celebration, FL, USA
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172
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Lallemant B, Moriniere S, Ceruse P, Lebalch M, Aubry K, Hans S, Dolivet G, Malard O, Bonduelle Q, Vergez S. Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall. Eur Arch Otorhinolaryngol 2017; 274:4211-4216. [PMID: 29032418 DOI: 10.1007/s00405-017-4771-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan-Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi2 test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.
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Affiliation(s)
- B Lallemant
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France.
| | - S Moriniere
- Department of Head and Neck Surgery, University Hospital Bretonneau, Tours, France
| | - P Ceruse
- Department of Head and Neck Surgery, Hospices Civils de Lyon, University Hospital Lyon-Nord, Lyon, France
| | - M Lebalch
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France
| | - K Aubry
- Department of Head and Neck Surgery, University Hospital Dupuytren, Limoges, France
| | - S Hans
- Department of Head and Neck Surgery, AP-HP, Georges Pompidou Hospital, Paris, France
| | - G Dolivet
- Department of Head and Neck Surgery, Centre Alexis Vautrin, Nancy, France
| | - O Malard
- Department of Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Q Bonduelle
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France
| | - S Vergez
- Department of Head and Neck Surgery, University Hospital Larrey, Toulouse, France
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173
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Turner MT, Byrd JK, Ferris RL. Current Role of Surgery in the Management of Oropharyngeal Cancer. J Oncol Pract 2017; 12:1176-1183. [PMID: 27858544 DOI: 10.1200/jop.2016.015263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe d'Oncologie Radiothérapie Tête et Cou trial. Since that time, human papillomavirus-associated oropharyngeal squamous cell carcinoma has been identified as a unique disease, with improved survival regardless of treatment modality. The improved outcomes of this population has led to re-evaluation of treatment paradigms in the past decade, with a desire to spare young, human papillomavirus-positive patients the treatment-related toxicities of chemoradiotherapy and to use new minimally invasive surgical techniques to improve outcomes. Numerous retrospective and prospective studies have investigated the role of surgery in treatment of oropharyngeal carcinoma and have demonstrated equivalent oncologic outcomes and improved functional outcomes compared with chemoradiotherapy protocols. Ongoing and future clinical trials may help delineate the role of surgery in the future.
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Affiliation(s)
- Meghan T Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
| | - J Kenneth Byrd
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
| | - Robert L Ferris
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
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174
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Virós Porcuna D, Avilés Jurado F, Pollán Guisasola C, Ramírez Ruiz RD, García Lorenzo J, Tobed Secall M, Vilaseca González I, Costa González JM, Soteras Olle J, Casamitjana Claramunt F, Sumarroca Trouboul A, Hijano Esqué R, Viscasillas Pallàs G, Mañós Pujol M, Quer Agustí M. Transoral Oropharyngeal Resection Classification: Proposal of the SCORL Working Group. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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175
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Virós Porcuna D, Avilés Jurado F, Pollán Guisasola C, Ramírez Ruiz RD, García Lorenzo J, Tobed Secall M, Vilaseca González I, Costa González JM, Soteras Olle J, Casamitjana Claramunt F, Sumarroca Trouboul A, Hijano Esqué R, Viscasillas Pallàs G, Mañós Pujol M, Quer Agustí M. Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:289-293. [DOI: 10.1016/j.otorri.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022]
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176
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Singh AK, Mimikos C, Groman A, Dibaj S, Platek AJ, Cohan DM, Hicks WL, Gupta V, Arshad H, Kuriakose MA, Warren GW, Platek ME. Combined surgery and radiation improves survival of tonsil squamous cell cancers. Oncotarget 2017; 8:112442-112450. [PMID: 29348837 PMCID: PMC5762522 DOI: 10.18632/oncotarget.20122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/31/2017] [Indexed: 01/07/2023] Open
Abstract
Objective The study evaluated the addition of surgery (S) to radiation (RT) on survival of squamous cell carcinomas (SCC) of tonsillar-fossa (TF) in a modern cohort with similar epidemiology and treatment as current patients. Study Design Retrospective analysis utilizing Surveillance, Epidemiology, and End Results (SEER) Program data. Results For all stages combined TF patients who received S+RT had superior OS (p < 0.01) and DSS (p < 0.01). For each stage OS and DSS was superior for S+RT (p < 0.05). In multivariate analysis, HRs for OS were statistically significantly higher for TF patients (stage 2, 3, and 4) receiving RT alone (p < 0.001). Materials and Methods TF SCC patients treated with either S+RT or RT alone between 2004 and 2011 were examined (n = 6,476). Primary outcome measures included overall survival (OS) and disease specific survival (DSS). Cox proportional hazard ratios (HR) were estimated for patients treated with S+RT compared to RT alone. Conclusions OS and DSS were superior for all stages combined and for stages 2, 3, and 4 in TF patients who received S+RT compared to RT alone.
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Affiliation(s)
- Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Christina Mimikos
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shiva Dibaj
- Department of Biostatistics, Roswell Park Cancer Institute, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Alexis J Platek
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - David M Cohan
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Wesley L Hicks
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Vishal Gupta
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Hassan Arshad
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Moni A Kuriakose
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Mary E Platek
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Health, Nutrition and Dietetics, Buffalo State College (SUNY), Buffalo, NY, USA
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Abstract
OPINION STATEMENT Given the potential for long-term toxicities from concurrent chemoradiation, there is great interest in surgery as a primary treatment modality for head and neck cancers, particularly in the younger HPV-positive oropharyngeal cancer patient. Transoral robotic surgery (TORS) has proven to be an effective technique to safely treat oropharyngeal and select supraglottic tumors surgically. Sound, traditional surgical principles are employed using improved endoscopic visualization and precise instrumentation to perform oncologic surgery without the morbidity of transmandibular or transcervical approaches. Although level 1 evidence prospective clinical trials are currently underway for TORS, the literature supports its safety and efficacy based on numerous studies. Currently, prospective randomized trials are underway to provide better evidence for or against TORS in oropharyngeal cancer. Patient selection based on comorbidities, anatomy, and available pathological data is critical in choosing patients for TORS.
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180
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Thankappan K, Dabas S, Deshpande M. Robotic retroauricular thyroidectomy: initial experience from India. Gland Surg 2017; 6:267-271. [PMID: 28713698 DOI: 10.21037/gs.2017.03.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Robotic thyroidectomy is getting accepted worldwide, but, majority of the literature is from South Korea. The purpose of this paper is to review the early experiences with robotic retroauricular (RA) thyroidectomy from India. The rationale for robotic thyroidectomy, its advantages and disadvantages are reviewed. The reasons for selecting the RA approach and the criteria used for selecting the patients are discussed. The early experience and outcomes of 29 patients, from three centres across India is presented. Robotic approaches score above endoscopic methods. RA approach may have some technical advantages for the head and neck surgeons. Sufficient cadaver and preclinical training should be undertaken. Standardized and formal teaching for robotic surgical skill is necessary. Case selection is important especially in the initial phases of the learning curve. Our early experience with robotic thyroidectomy was encouraging.
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Affiliation(s)
- Krishnakumar Thankappan
- Department of Head and Neck surgery and Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, India
| | - Surender Dabas
- Department of Surgical Oncology, Rajiv Gandhi Cancer Hospitals, New Delhi, India
| | - Mandar Deshpande
- Department of Surgical Oncology, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, India
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181
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Controversies in Postoperative Irradiation of Oropharyngeal Cancer After Transoral Surgery. Surg Oncol Clin N Am 2017; 26:357-370. [DOI: 10.1016/j.soc.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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182
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Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): A prospective trial. Oral Oncol 2017; 69:80-83. [DOI: 10.1016/j.oraloncology.2017.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 11/23/2022]
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183
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Hamilton D, Paleri V. Role of transoral robotic surgery in current head & neck practice. Surgeon 2017; 15:147-154. [DOI: 10.1016/j.surge.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
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184
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Kubik M, Mandal R, Albergotti W, Duvvuri U, Ferris RL, Kim S. Effect of transcervical arterial ligation on the severity of postoperative hemorrhage after transoral robotic surgery. Head Neck 2017; 39:1510-1515. [PMID: 28570011 DOI: 10.1002/hed.24677] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/19/2016] [Accepted: 11/08/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear. METHODS A retrospective single institution study was performed to identify risk factors for hemorrhage after TORS for oropharyngeal squamous cell carcinoma (SCC). RESULTS Overall, 13.2% of patients (35/265) experience postoperative hemorrhage. T classification, perioperative use of anticoagulants, surgeon experience >50 cases, and tumor subsite were not predictors of postoperative hemorrhage. Of this cohort, 28% underwent prophylactic arterial ligation. The overall incidence of bleeding was not significantly decreased in patients who underwent arterial ligation (12.1% vs 13.6%; p = .84). However, arterial ligation significantly reduced the incidence of major and severe bleeding events (1.3% vs 7.8%; p = .04). Radiation before TORS was a risk factor for major and severe postoperative hemorrhage (p < .02). CONCLUSION Transcervical arterial ligation during TORS may reduce the severity of postoperative hemorrhagic events. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1510-1515, 2017.
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Affiliation(s)
- Mark Kubik
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rajarsi Mandal
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Albergotti
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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185
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Schoppy DW, Kupferman ME, Hessel AC, Bell DM, Garland EM, Damrose EJ, Holsinger FC. Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx. CANCERS OF THE HEAD & NECK 2017; 2:5. [PMID: 31093352 PMCID: PMC6460795 DOI: 10.1186/s41199-017-0024-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
Abstract
Background Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence. Conclusion In this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies. Trial registration number None/not applicable Electronic supplementary material The online version of this article (doi:10.1186/s41199-017-0024-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David W Schoppy
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
| | - Michael E Kupferman
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Amy C Hessel
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Diana M Bell
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Elizabeth M Garland
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Edward J Damrose
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
| | - F Christopher Holsinger
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
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186
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Frenkel CH, Yang J, Zhang M, Altieri MS, Telem DA, Samara GJ. Compared Outcomes of Concurrent versus Staged Transoral Robotic Surgery with Neck Dissection. Otolaryngol Head Neck Surg 2017; 157:791-797. [DOI: 10.1177/0194599817706499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Outcomes of concurrent versus staged neck dissection with transoral robotic surgery have not been studied. This study compares outcomes of concurrent versus staged transoral robotic surgery and neck dissection. Design Retrospective administrative database analysis. Setting Article 28 licensed inpatient and outpatient care facilities in New York State. Subjects/Methods Adults undergoing transoral robotic surgery with staged or concurrent neck dissection from 2008 to 2014 were identified in the New York Statewide Planning and Research Collaborative System database. We compared complications, readmissions, subsequent procedures, and length of stay for concurrent versus staged procedures with multivariable logistic regression and multiple linear regression models. Results Of the 425 patients undergoing transoral robotic surgery and neck dissection, 333 had concurrent procedures, and 92 had staged. Risk-adjusted length of stay for concurrent procedures was 42.3% less than that of staged procedures ( P < .0001). Neck dissection timing was not associated with postoperative complications ( P = .41), readmissions ( P = .67), or additional procedures, including reconstruction, tracheostomy, or gastrostomy ( P = .17, .84, .82, respectively). Bleeding (7.8%) was the most common complication, and the majority (78.8%) required reoperation. Bleeding or surgical error was not associated with either concurrent or staged surgery (concurrent vs staged: adjusted odds ratio, 0.68; 95% CI, 0.35-1.37; P = .26). Conclusions Concurrent and staged procedures are equivalent with respect to adverse events, but length of stay is shorter for concurrent procedures. Cost and clinical benefits associated with length of stay are unknown, and it is reasonable to allow operator preference and patient factors to determine surgical logistics.
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Affiliation(s)
- Catherine H. Frenkel
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Mengru Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York USA
| | - Maria S. Altieri
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Dana A. Telem
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Ghassan J. Samara
- Division of Otolaryngology–Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
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187
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Albergotti WG, Jordan J, Anthony K, Abberbock S, Wasserman-Wincko T, Kim S, Ferris RL, Duvvuri U. A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 2017; 123:3132-3140. [PMID: 28467606 DOI: 10.1002/cncr.30712] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology compared with chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study was to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS Patients undergoing TORS for OPSCC were enrolled prospectively. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score >2) and was administered on postoperative day (POD) 1, 7, and 30. Patient demographics, weight, pain level, and clinical outcomes were recorded prospectively and focused on time to oral diet, feeding tube placement, and dysphagia-related readmissions. RESULTS A total of 51 patients were included with pathologic T stages of T1 (n = 24), T2 (n = 20), T3 (n = 3), and Tx (n = 4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD 1 was lower than on POD 7 (21.5 vs 26.6; P = .005) but decreased by POD 30 (26.1 to 12.2; P < .001). Forty-seven (92.1%) patients were discharged on an oral diet, but 57.4% required compensatory strategies or modification of liquid consistency. Ninety-eight percent of patients were taking an oral diet by POD 30. There were no dysphagia-related readmissions. CONCLUSION This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month postoperatively, but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions. Cancer 2017;123:3132-40. © 2017 American Cancer Society.
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Affiliation(s)
- William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jessica Jordan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keely Anthony
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shira Abberbock
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
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188
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189
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Hay A, Migliacci J, Karassawa Zanoni D, Boyle JO, Singh B, Wong RJ, Patel SG, Ganly I. Complications following transoral robotic surgery (TORS): A detailed institutional review of complications. Oral Oncol 2017; 67:160-166. [PMID: 28351571 PMCID: PMC5407467 DOI: 10.1016/j.oraloncology.2017.02.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/06/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report the complications occurring following TORS and to identify the factors predictive of complications. METHODS Following IRB approval a retrospective analysis of all TORS operations at our institution was performed. Postoperative complications within 45days were collected and graded with the Clavien-Dindo system. Complications were categorized into groups: all complications, not related to TORS and TORS related. Unadjusted odds ratios were calculated to test association between patients with and without a complication. RESULTS 122 TORS operations were carried out between June 2010 and August 2015. 77% were male, with a median age of 57. There were 92 primary tumor resections, 10second head and neck primary resections, 13 salvage procedures and 7 other indications. Surgical resection involved 1, 2 or >3 sub-sites in 36%, 28% and 36% patients, respectively. Overall, there were 107 complications (66 TORS related, 41 non-TORS related) that occurred in 57 patients (47%). A major complication occurred in 23 patients (18%). 19 patients had a TORS related major complication and 6 patients experienced a non-TORS related major complication. There was a temporal trend in TORS related major complication rate decreasing from 33% in 2010 to 10% in 2015. Statistical analysis showed that the odds of having any complication were 3 times greater in patients over 60years old (p=0.017), and 2.5 times greater when there were more than 2 subsites resected (p=0.022). CONCLUSIONS Age over 60years and a larger extent of resection were the significant factors predictive of major complications.
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Affiliation(s)
- Ashley Hay
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jocelyn Migliacci
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Daniella Karassawa Zanoni
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jay O Boyle
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Bhuvanesh Singh
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Richard J Wong
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Snehal G Patel
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Ian Ganly
- Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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190
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Biron VL, O'Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC, Côté DWJ, Harris J, Seikaly H. Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis. J Otolaryngol Head Neck Surg 2017; 46:20. [PMID: 28292318 PMCID: PMC5351107 DOI: 10.1186/s40463-017-0196-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas. Methods Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups. Results Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications. Conclusion TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.
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Affiliation(s)
- Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada. .,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada.
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
| | - Brittany Barber
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Colin Andrews
- Faculty of Medicine and Dentistry, Undergraduate Medical Education, Edmonton, AB, Canada
| | - Caroline C Jeffery
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - David W J Côté
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
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191
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Morisod B, Venara-Vulpe II, Alzuphar S, Monnier Y, Bongiovanni M, Hagmann P, Bouchaab H, Bourhis J, Simon C. Minimizing adjuvant treatment after transoral robotic surgery through surgical margin revision and exclusion of radiographic extracapsular extension: A Prospective observational cohort study. Head Neck 2017; 39:965-973. [DOI: 10.1002/hed.24712] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/30/2016] [Accepted: 12/12/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Benoit Morisod
- Department of Otolaryngology - Head and Neck Surgery, CHUV; University of Lausanne; Lausanne Switzerland
| | - Ioana I. Venara-Vulpe
- Department of Otolaryngology - Head and Neck Surgery, CHUV; University of Lausanne; Lausanne Switzerland
| | - Stephen Alzuphar
- Department of Otolaryngology - Head and Neck Surgery, CHUV; University of Lausanne; Lausanne Switzerland
| | - Yan Monnier
- Department of Otolaryngology - Head and Neck Surgery, CHUV; University of Lausanne; Lausanne Switzerland
| | | | - Patric Hagmann
- Department of Radiology, CHUV; University of Lausanne; Lausanne Switzerland
| | - Hanan Bouchaab
- Department of Radiation Oncology, CHUV; University of Lausanne; Lausanne Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, CHUV; University of Lausanne; Lausanne Switzerland
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV; University of Lausanne; Lausanne Switzerland
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192
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Meulemans J, Vanclooster C, Vauterin T, D'heygere E, Nuyts S, Clement PM, Hermans R, Delaere P, Vander Poorten V. Up-front and Salvage Transoral Robotic Surgery for Head and Neck Cancer: A Belgian Multicenter Retrospective Case Series. Front Oncol 2017; 7:15. [PMID: 28232904 PMCID: PMC5298968 DOI: 10.3389/fonc.2017.00015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/23/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION/AIM We analyzed the functional and oncologic outcomes of primary and salvage transoral robotic surgery (TORS) procedures, performed in three Belgian institutions with a similar philosophy. PATIENTS AND METHODS A total of 86 patients who underwent TORS between 24-12-2009 and 25-09-2015 were retrospectively reviewed. Descriptive statistics, overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS; Kaplan-Meier), and the variation of these outcomes according to whether patients had primary or salvage TORS were evaluated (univariate log-rank analysis). RESULTS Of 86 patients, 56 (65.1%) underwent TORS as a primary treatment and 30 (34.9%) as a salvage procedure for recurrent or second primary cancer. Tumor location was mainly oropharynx (N = 63; 73.3%) followed by supraglottic larynx (N = 11; 12.8%), hypopharynx (N = 11; 12.8%), and glottic larynx (N = 1; 1.2%). In the up-front TORS group, most tumors were classified as cT1 (N = 23; 41.1%)/pT1 (N = 24; 42.9%) or cT2 (N = 27; 48.2%)/pT2 (N = 27; 48.2%) and cN0 (N = 18; 32.1%), cN1 (N = 13; 23.2%), or cN2 (N = 25; 44.6%). In the salvage TORS group, most tumors were cT1-rT1 (N = 18; 60.0%)/pT1-rpT1 (N = 18; 60.0%) or cT2-rT2 (N = 12; 40.0%)/pT2-rpT2 (N = 7; 23.3%) and cN0 (N = 25; 83.3%). Neck dissection was performed in 87.5% of primary cases and 30.0% of salvage cases. In the up-front TORS group, patients were postoperatively submitted to follow-up (N = 13; 23.2%) or received adjuvant radiotherapy, either as single modality (N = 26; 46.4%) or with concomitant cisplatin (N = 15; 26.8%). On the other hand, most salvage TORS patients did not receive any adjuvant therapy (N = 19; 63.3%). Mean and median follow-up was 23.1 and 21.2 months, respectively. Functional results were excellent (no definitive tracheostomy, long-term tube feeding in 1.8% of primary cases, and 20% of salvage cases). In the up-front TORS group, estimated 2-year OS was 88.5% (SE = 5.0%), 2-year DSS was 91.8% (SE = 4.6%) and 2-year DFS was 86.1% (SE = 5.3%). In the salvage TORS group, estimated 2-year OS was 73.5% (SE = 10.9%), 2-year DSS was 93.3% (SE = 6.4%), and 2-year DFS was 75.8% (SE = 9.7%). Comparing outcome of primarily treated patients to salvage patients, a non-statistically significant trend toward better OS (p = 0.262) and DFS (p = 0.139) was observed. CONCLUSION This retrospective study confirms favorable oncologic and functional outcomes of TORS for selected head and neck malignancies, both in the primary and in the salvage setting.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Christophe Vanclooster
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium
| | - Tom Vauterin
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan , Bruges , Belgium
| | - Emmanuel D'heygere
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Sandra Nuyts
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - Paul M Clement
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven , Leuven , Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven , Leuven , Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Geltzeiler M, Clayburgh D, Gleysteen J, Gross ND, Hamilton B, Andersen P, Brickman D. Predictors of extracapsular extension in HPV-associated oropharyngeal cancer treated surgically. Oral Oncol 2017; 65:89-93. [DOI: 10.1016/j.oraloncology.2016.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/21/2016] [Accepted: 12/26/2016] [Indexed: 12/27/2022]
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195
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Gorphe P, Von Tan J, El Bedoui S, Hartl DM, Auperin A, Qassemyar Q, Moya-Plana A, Janot F, Julieron M, Temam S. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi. J Robot Surg 2017; 11:455-461. [PMID: 28064382 DOI: 10.1007/s11701-017-0679-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 11/26/2022]
Abstract
The latest generation Da Vinci® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Jean Von Tan
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Dana M Hartl
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Anne Auperin
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Quentin Qassemyar
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Stephane Temam
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
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196
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Geltzeiler M, Doerfler S, Turner M, Albergotti WG, Kubik M, Kim S, Ferris R, Duvvuri U. Transoral robotic surgery for management of cervical unknown primary squamous cell carcinoma: Updates on efficacy, surgical technique and margin status. Oral Oncol 2017; 66:9-13. [PMID: 28249654 DOI: 10.1016/j.oraloncology.2016.12.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/27/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Management of cervical unknown primary squamous cell carcinoma (CUP) has evolved with the introduction of transoral robotic surgery (TORS). OBJECTIVES 1. To describe the efficacy of TORS lingual and palatine tonsillectomy in identifying the primary site of malignancy. 2. To explore how the extent of surgery affects diagnostic yield. 3. To report margin status of TORS resections. DESIGN, SETTING AND PARTICIPANTS A retrospective, single-center cohort study utilizing a prospectively collected database of CUP patients in a high-volume tertiary referral center. Patient underwent operative laryngoscopy plus TORS as clinically indicated. MAIN OUTCOMES AND MEASURES Primary end point was successful identification of the primary. The extent of surgery and margin status were also examined. RESULTS From 2010-2016, 64 patients with CUP were treated. The primary tumor was found in 51 patients (80%). Fourteen patients (22%) were identified with operative laryngoscopy alone. Fifty patients underwent TORS lingual tonsillectomy ± palatine tonsillectomy with 37 primary tumors identified (74%). The primary was located in the lingual tonsil in 32 patients (86%) and palatine tonsil in 5 patients (10%, p<0.001). Negative margins were achieved in 19 patients (51%). The deep margin was the most commonly positive margin (47%, p=0.049). CONCLUSION AND RELEVANCE Operative laryngoscopy with TORS is efficacious, localizing the primary in 80% of patients. If a margin was positive, it was most commonly the deep margin. This study provides valuable information that can help standardize surgical technique, further increasing the diagnostic yield and decreasing the negative margin rate of TORS for CUP.
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Affiliation(s)
- Mathew Geltzeiler
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sean Doerfler
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Meghan Turner
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William Greer Albergotti
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Kubik
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Seungwon Kim
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Ferris
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Umamaheswar Duvvuri
- UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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197
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Rubek N, Channir HI, Charabi BW, Lajer CB, Kiss K, Nielsen HU, Bentzen J, Friborg J, von Buchwald C. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. Eur Arch Otorhinolaryngol 2017; 274:2229-2237. [DOI: 10.1007/s00405-016-4433-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/16/2016] [Indexed: 12/18/2022]
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198
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An Y, Holsinger FC, Husain ZA. De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer. CANCERS OF THE HEAD & NECK 2016; 1:18. [PMID: 31093347 PMCID: PMC6460758 DOI: 10.1186/s41199-016-0016-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/23/2016] [Indexed: 06/09/2023]
Abstract
Current adjuvant treatment guidelines for oropharyngeal squamous cell carcinoma treated with primary surgery are based on studies that predate the human papillomavirus (HPV) era. HPV-associated oropharynx carcinoma (HPV-OPC) has a much more favorable prognosis compared to HPV-unassociated cancer and is increasingly considered to be a distinct disease entity due to its unique etiology, presentation, and behavior. Currently, there is significant interest in adjuvant treatment de-intensification of HPV-OPC patients in order to reduce treatment-related toxicity while maintaining excellent clinical outcomes. Here, we review the evidence and rationale underlying the ongoing prospective trials of adjuvant treatment de-intensification for HPV-OPC patients.
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Affiliation(s)
- Yi An
- Department of Therapeutic Radiology, Yale University School of Medicine, Smilow Cancer Hospital LL 515, 35 Park St, New Haven, CT 06510 USA
| | - F. Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305 USA
| | - Zain A. Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, Smilow Cancer Hospital LL 515, 35 Park St, New Haven, CT 06510 USA
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199
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Frenkel CH, Yang J, Zhang M, Regenbogen E, Telem DA, Samara GJ. Trends and the utilization of transoral robotic surgery with neck dissection in New York State. Laryngoscope 2016; 127:1571-1576. [PMID: 27882552 DOI: 10.1002/lary.26345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/26/2016] [Accepted: 09/02/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The timing of neck dissection (ND) in relation to transoral robotic surgery (TORS) is controversial. This study identifies local practice patterns and economic and social access disparities during adoption of TORS. STUDY DESIGN We analyzed utilization patterns of TORS and ND using the New York Statewide Planning and Research Cooperative System all-payer administrative database. Statewide head and neck cancer incidence from the Centers for Disease Control and Prevention (Bethesda, MD) was used to control for overall cancer incidence. METHODS Patient demographic, insurer, and institutional information of patients aged ≥ 18 (n = 225) years from 2008 to 2012 were evaluated. Temporal trends were analyzed with Poisson regression models for counts. RESULTS Transoral robotic surgery was used in 386 procedures, and 58.3% involved ND (n = 225). Concurrent ND was most frequent (n = 173), followed by staged TORS then ND (n = 44) and staged ND preceding TORS (n = 8). Caucasians were more likely than Blacks/Hispanics to undergo TORS (P = 0.03). Medicare (26.2%) and Medicaid (2.7%) payers comprised a minority of patients compared to those commercially insured (70.2%). Only 20% of patients received care outside a major urban center, and these patients were more likely to undergo staged procedures, P = 0.02. Staged procedures resulted in higher mean hospital charges (P = 0.02). CONCLUSION Concurrent TORS + ND, the most common practice in New York, is more cost-effective. Patients without commercial insurance, patients in racial minorities, or patients residing outside major urban centers may be targeted to improve care access disparities with respect to minimally invasive TORS technology. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:1571-1576, 2017.
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Affiliation(s)
- Catherine H Frenkel
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Mengru Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Elliot Regenbogen
- Division of Otolaryngology-Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Dana A Telem
- Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - Ghassan J Samara
- Division of Otolaryngology-Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A
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200
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Gross ND, Weber RS. Has the Pendulum Swung Back to Surgery First for Oropharyngeal Cancer? J Oncol Pract 2016; 12:1189-1191. [PMID: 27858542 DOI: 10.1200/jop.2016.017921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Neil D Gross
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Randal S Weber
- The University of Texas MD Anderson Cancer Center, Houston, TX
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