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Laccourreye O, Garcia D, Rahman A, Holsinger FC. Ten-Year Efficacy of Transoral Surgery for Squamous Carcinoma of the Lateral Oropharynx. Laryngoscope 2024. [PMID: 38932658 DOI: 10.1002/lary.31574] [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: 01/19/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To document the 10-year results of transoral mandibular preservation surgery for patients with T1-2 squamous cell carcinoma (SCC) arising from the lateral oropharynx. METHODS This was a retrospective 30-year review using STROBE guidelines at an academic, tertiary referral center. A total of 294 patients with T1-2 SCC of the lateral oropharynx were reviewed. Only 19% of patients were never-smokers, suggesting a predominantly HPV-negative population. All patients had transoral mandibular preservation surgery. Follow-up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and postoperative radiation therapy (31.6%) Local control, survival, and functional endpoints, as well as the consequences of local recurrence, were analyzed. RESULTS The 10-year local disease control was 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% local control rate. The overall 10-year survival was 50%. Mortality was related to metachronous second primary cancer (MSPC) (29.2%), medical comorbidities (25.7%), uncontrolled local recurrence (10%), and complications following transoral resection (4.2%). In multivariate analysis, the development of an MSPC significantly increased (p < 0.005) the risk of death. Overall, 95.2% of patients achieved mandibular preservation. However, gastrostomy and tracheostomy dependence occurred in 1% and 0.3% of cases, respectively. CONCLUSIONS For a patient population with a significant percentage of tobacco-associated oropharyngeal cancer (OPC), transoral surgery was associated with long-term minimal postoperative complications and a high rate of local control. MSPC was the main cause of death during the first 10 postoperative years. Such long-term figures support transoral surgery as an effective first-line treatment for early-stage predominantly tobacco-related OPC. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Ollivier Laccourreye
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Paris, France
| | - Dominique Garcia
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Paris, France
| | - Arifeen Rahman
- Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A
| | - F C Holsinger
- Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A
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Costantino A, Sampieri C, De Virgilio A, Kim SH. Neo-adjuvant chemotherapy and transoral robotic surgery in locoregionally advanced oropharyngeal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107121. [PMID: 37879162 DOI: 10.1016/j.ejso.2023.107121] [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] [Received: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To analyze the oncological outcomes and patterns of recurrence of patients with locoregionally advanced oropharyngeal squamous cell carcinoma (OPSCC) who underwent neo-adjuvant chemotherapy (NCT) with subsequent transoral robotic surgery (TORS). METHODS A single-center retrospective cohort study was performed, including 198 patients (mean age: 58.6, SD: 9.2). The primary outcome was disease-free survival (DFS). RESULTS The median follow-up time was 26.5 months (IQR: 16.0-52.0). Estimated DFS rates (95 % CI) at 1 and 3 years were 86.6 % (81.9-91.7), and 81.4 % (75.7-87.6), respectively. Estimated DSS rates (95 % CI) at 1 and 3 years were 96.7 % (94.1-99.3), and 92.6 % (88.4-97.0), respectively. Estimated OS rates (95 % CI) at 1 and 3 years were 96.2 % (93.4-99.0), and 88.7 % (83.4-94.2), respectively. A total of 31 (15.6 %) patients showed a disease relapse after a median time of 8 months (IQR: 4.0-12.0), but only 12 (6 %) patients died of the disease during the study period. CONCLUSIONS This study demonstrates that NCT and TORS can obtain excellent tumor control and survival in locoregionally advanced OPSCC. NCT might reduce the need for adjuvant treatments, and randomized clinical trials should be conducted to better define this aspect.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Claudio Sampieri
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
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De Virgilio A, Costantino A, Rizzo D, Crescio C, Gallus R, Spriano G, Mercante G, Festa BM, Accorona R, Pignataro L, Capaccio P, Bussu F. Do We Have Enough Evidence to Specifically Recommend Transoral Robotic Surgery in HPV-Driven Oropharyngeal Cancer? A Systematic Review. Pathogens 2023; 12:pathogens12020160. [PMID: 36839432 PMCID: PMC9959572 DOI: 10.3390/pathogens12020160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction: International guidelines include transoral robotic surgery (TORS) as an option for selected oropharyngeal squamous cell carcinomas (OPSCCs). In the perspective of treatment de-intensification, many surgeons have started recommending and performing TORS preferentially in p16- positive OPSCC in order to reduce the long-term morbidity related to chemoradiotherapy. The aim of the present review is to analyze the current evidence supporting the above-cited strategy. Materials and Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twenty-two studies were included in this review, with a total of 3992 patients treated with primary TORS. The majority of patients were classified as HPV+ (n = 3655, 91.6%), and 8.2% (n = 327) as HPV-. The HPV status was unknown in only 10 (0.3%) patients. In particular, only five of the included studies compared survival outcomes of HPV-positive patients with HPV-negative ones treated with primary TORS, and only two of these found a significant improvement in survival in the HPV-driven cohort. Discussion: The current literature does not clarify whether HPV+ OPSCCs treated with TORS, alone or with adjuvant treatments, are associated with a better oncologic and/or functional outcome compared to those treated with radio- or chemoradiotherapy. However, TORS alone obtained good oncological outcomes in a high percentage of cases in the reviewed series. Recent data, on the other hand, suggest that TORS could represent a promising strategy for intensifying treatments in HPV- OPSCC.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20089 Milan, Italy
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20089 Milan, Italy
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy
| | - Davide Rizzo
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Claudia Crescio
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Roberto Gallus
- Mater Hospital Olbia, Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20089 Milan, Italy
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20089 Milan, Italy
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20089 Milan, Italy
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy
- Correspondence: ; Tel.: +39-02-8224-7550; Fax: +39-02-8224-7550
| | - Remo Accorona
- Unit of Otorhinolaryngology–Head and Neck Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Lorenzo Pignataro
- Unit of Otorhinolaryngology–Head and Neck Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Pasquale Capaccio
- Unit of Otorhinolaryngology–Head and Neck Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Francesco Bussu
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro, 07100 Sassari, Italy
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Li H, Zhang X, Chen W, Zhang Q, Li Q, Chen S, Yang Z, Su X, Yan S, Yang A, Song M. Analysis of T1-T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery. Laryngoscope Investig Otolaryngol 2023; 8:103-112. [PMID: 36846425 PMCID: PMC9948596 DOI: 10.1002/lio2.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Transoral robotic surgery (TORS) has become an effective treatment for early-stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)-positive and HPV-negative OPSCC in China. Methods Patients with OPSCC of pT1-T2 stage who underwent TORS from March 2017 to December 2021 were analyzed. Results A total of 83 patients (HPV-positive, n = 25; HPV-negative, n = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long-term tracheotomy. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV-positive group and HPV-negative group were 100% versus 84.3% (P = .07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence (P < .05). Conclusion Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1-T2 stage OPSCC treatment, regardless of HPV status. Level of Evidence 4.
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Affiliation(s)
- Hui Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xing Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wenkuan Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Quan Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Qiuli Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shuwei Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Zhongyuan Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xuan Su
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shida Yan
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ankui Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ming Song
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
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5
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Watanabe Y, Tanaka S, Hasebe K, Hiratsuka Y, Yoshida T, Kusano J, Hori S, Okamura K, Tanaka C, Fujikawa S, Osada Y, Minoyama M. Long‐Term
Outcomes of
End‐Flexible‐Rigidscopic
Transoral Surgery for Pharyngolaryngeal Cancer. Laryngoscope 2022; 133:1415-1424. [PMID: 36053729 DOI: 10.1002/lary.30316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE End-flexible-rigidscopic transoral surgery (E-TOS) is a new and minimally invasive transoral surgery for resection of Tis-selected T3 pharyngolaryngeal cancers. We evaluated long-term oncological outcomes and whether postoperative voice and swallowing function were preserved following E-TOS. METHODS In this retrospective single-center study, 154 patients treated with E-TOS using a curved retractor, flexible-tip rigid endoscope, and thin curved instruments were included. Their survival rate, larynx preservation rate, and disease control rate were estimated using the Kaplan-Meier method. Postoperative voice function was evaluated using both objective and subjective tests. Postoperative swallowing function was assessed using the Hyodo score and the functional outcome swallowing scale. RESULTS The 3-year and 5-year overall survival, disease-specific survival, disease-free survival, laryngectomy-free survival, local control, and loco-regional control rates post E-TOS were 89.8% and 82.2%, 95.6% and 92.3%, 78.5% and 70.3%, 87.2% and 80.9%, 93.9% and 92.5%, and 87.2% and 85.7%, respectively. Both objective and subjective postoperative voice and swallowing function tests were within normal limits in more than 90% of the patients. CONCLUSION E-TOS is an effective, safe, low-cost, and minimally invasive transoral surgery for Tis-selected T3 pharyngolaryngeal cancer; it also preserves postoperative voice, larynx, and swallowing function. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1415-1424, 2023.
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Affiliation(s)
- Yoshiki Watanabe
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
- Department of Otolaryngology‐Head & Neck Surgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Shinzo Tanaka
- Department of Otolaryngology‐Head & Neck Surgery Uji‐Tokushukai Medical Center Kyoto Japan
| | - Koki Hasebe
- Department of Otolaryngology‐Head & Neck Surgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yasuyuki Hiratsuka
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
| | - Takao Yoshida
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
| | - Junko Kusano
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
| | - Shusei Hori
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
| | - Kana Okamura
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
| | - Chisato Tanaka
- Department of Otolaryngology‐Head & Neck Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Shiori Fujikawa
- Department of Otolaryngology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yuka Osada
- Department of Otolaryngology‐Head & Neck Surgery Japanese Red Cross Osaka Hospital Osaka Japan
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Bollig CA, Morris B, Stubbs VC. Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus-negative oropharyngeal cancer. Head Neck 2022; 44:1545-1553. [PMID: 35365915 PMCID: PMC9324989 DOI: 10.1002/hed.27045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgery + adjuvant therapy was shown to have improved overall survival (OS) versus nonsurgical treatment in T1-T2N1-N2b human papillomavirus (HPV)-negative oropharyngeal cancer (OPC). Our objective was to compare OS in transoral robotic surgery (TORS) with neck dissection versus nonsurgical treatment for T1-T2N0 HPV-negative OPC. METHODS Patients with T1-T2N0 HPV-negative OPC were identified in the National Cancer Database. OS was compared between groups: (1) TORS with neck dissection +/- adjuvant therapy, (2) primary radiotherapy (>60 Gy) +/- chemotherapy using Kaplan-Meier and multivariable Cox proportional hazards models. RESULTS There were 665 (78.4%) patients treated nonsurgically and 183 (21.6%) patients in the TORS group. Adjusting for age, comorbidity score, facility type, tumor subsite, and tumor stage, primary nonsurgical treatment was associated with worse OS (hazard ratio: 1.90, 95% CI: 1.34-2.69). CONCLUSION For T1-T2N0 HPV-negative OPC, TORS with neck dissection may be associated with a survival benefit over nonsurgical treatment.
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Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology – Head and Neck SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Brian Morris
- Department of SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Vanessa C. Stubbs
- Department of Otolaryngology – Head and Neck SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
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