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Malard O, Karakachoff M, Ferron C, Hans S, Vergez S, Garrel R, Gorphe P, Ramin L, Santini L, Villeneuve A, Lasne-Cardon A, Espitalier F, Hounkpatin A. Oncological and functional outcomes for transoral robotic surgery following previous radiation treatment for upper aerodigestive tract head and neck cancers. A French multicenter GETTEC group study. Cancer Med 2024; 13:e7031. [PMID: 38545809 PMCID: PMC10974718 DOI: 10.1002/cam4.7031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) opens new perspectives. We evaluated the outcomes for patients having undergone TORS after previous radiotherapy. METHODS A retrospective multicenter study (n = 138) in a previously irradiated area between 2009 and 2020. Survival was assessed with the Kaplan-Meier method. Prognostic factors were evaluated using a chi-squared test, Fisher's test, or Wilcoxon's test. RESULTS The median length of hospital stay was 12.5 days. Bleeding was the most frequent postoperative complication (15.2%, n = 22). Prophylactic vessel ligation did not significantly decrease bleeding. Complications were significantly lower for Tis, T1, and N0 tumors. 91.6% (n = 120) of the patients with a perioperative tracheotomy could be decannulated. Larynx was functional for 65.94% of the patients. The median length of follow-up was 26 months. The 5-year overall and relapse-free survival rates were respectively 59.9% and 43.4%. CONCLUSION Oncological and functional results confirmed the value of TORS as a treatment in previously irradiated area.
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Affiliation(s)
- Olivier Malard
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Matilde Karakachoff
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, Nantes, France
| | - Christophe Ferron
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Suresnes, France
| | - Sébastien Vergez
- Head and Neck Surgery Department, Cancer Institute Toulouse-Oncopole, Toulouse, France
| | - Renaud Garrel
- Department of Head and Neck Surgery, Montpellier Guy De Chauliac University Hospital, Montpellier, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Lionel Ramin
- Department of Head and Neck Surgery, Limoges Dupuytrens University Hospital, Limoges, France
| | - Laure Santini
- ENT-Head and Neck Surgery Department, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Alexandre Villeneuve
- Head and Neck Surgery Department, Georges-Pompidou European Hospital, Paris, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer center, Normandie University, Caen, France
| | - Florent Espitalier
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Audrey Hounkpatin
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
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2
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Bandara DL, Kanmodi KK, Salami AA, Aladelusi TO, Chandrasiri A, Amzat J, Jayasinghe RD. Quality of life of patients treated with robotic surgery in the oral and maxillofacial region: a scoping review of empirical evidence. BMC Oral Health 2024; 24:276. [PMID: 38408988 PMCID: PMC10895822 DOI: 10.1186/s12903-024-04035-w] [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: 11/08/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND There is a blooming trend in the application of robotic surgery in oral and maxillofacial care, and different studies had evaluated the quality of life (QoL) outcomes among patients who underwent robotic surgery in the oral and maxillofacial region. However, empirical evidence on the QoL outcomes from these procedures is yet to be mapped. Thus, this study was conducted to evaluate the available scientific evidence and gaps concerning the QoL outcomes of patients treated with robotic surgery in the oral and maxillofacial region. METHODS This study adopted a scoping review design, and it was conducted and reported based on the Arksey and O'Malley, PRISMA-ScR, and AMSTAR-2 guidelines. SCOPUS, PubMed, CINAHL Complete, and APA PsycINFO were searched to retrieve relevant literature. Using Rayyan software, the retrieved literature were deduplicated, and screened based on the review's eligibility criteria. Only the eligible articles were included in the review. From the included articles, relevant data were charted, collated, and summarized. RESULTS A total of 123 literature were retrieved from the literature search. After deduplication and screening, only 18 heterogeneous original articles were included in the review. A total of 771 transoral robotic surgeries (TORSs) were reported in these articles, and the TORSs were conducted on patients with oropharyngeal carcinomas (OPC), recurrent tonsillitis, and obstructive sleep apnoea (OSA). In total, 20 different QoL instruments were used in these articles to assess patients' QoL outcomes, and the most used instrument was the MD Anderson Dysphagia Inventory Questionnaire (MDADI). Physical functions related to swallowing, speech and salivary functions were the most assessed QoL aspects. TORS was reported to result in improved QOL in patients with OPC, OSA, and recurrent tonsillitis, most significantly within the first postoperative year. Notably, the site of the lesion, involvement of neck dissections and the characteristics of the adjuvant therapy seemed to affect the QOL outcome in patients with OPC. CONCLUSION Compared to the conventional treatment modalities, TORS has demonstrated better QoL, mostly in the domains related to oral functions such as swallowing and speech, among patients treated with such. This improvement was most evident within the initial post-operative year.
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Affiliation(s)
- Dhanushka Leuke Bandara
- Department of Oral Medicine and Periodontology, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kehinde Kazeem Kanmodi
- School of Dentistry, University of Rwanda, Kigali, Rwanda.
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia.
- Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria.
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
| | - Afeez Abolarinwa Salami
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
- Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | | | - Ayodhya Chandrasiri
- Department of Oral and Maxillofacial Surgery, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jimoh Amzat
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Department of Sociology, Usmanu Danfodiyo University, Sokoto, Nigeria
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
| | - Ruwan Duminda Jayasinghe
- Department of Oral Medicine and Periodontology, University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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3
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Kaya KH, Karaman Koç A, Kayhan FT. Health-Related Quality-of-Life Outcomes after Transoral Robotic Surgery for T1 and T2 Supraglottic Laryngeal Carcinoma Compared to the Transcervical Open Supraglottic Approach. ORL J Otorhinolaryngol Relat Spec 2022; 84:378-386. [PMID: 35130551 DOI: 10.1159/000521844] [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: 06/14/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This prospective controlled study evaluated and compared health-related quality of life (HRQOL), after transoral robotic supraglottic laryngectomy (TORSGL) versus transcervical open supraglottic laryngectomy (TCOSGL) in patients with T1 and T2 supraglottic laryngeal carcinoma (SLC). METHODS The TORSGL group comprised 14 patients, and the TCOSGL group comprised 13 patients. All 27 patients completed the European Organization for Research and Treatment of Cancer 30-item core quality-of-life questionnaire version 3.0 (EORTC QLQ-C30), the European Organization for Research and Treatment of Cancer head-and-neck cancer-specific module (EORTC QLQ-H&N35), before treatment and during the early and the late postoperative periods. RESULTS The present prospective study demonstrated the near-term postoperative HRQOL of patients with T1 or T2 SLC treated with TORSGL (Group A) or TCOSGL (Group B). On comparison of EORTC QLQ-C30 data for the two groups in the early postoperative period, all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B and in the late postoperative period, other than the cognitive function score (p = 0.450), all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B. On comparison of the EORTC QLQ-H&N35 data for the two groups in the early postoperative period, except for the teeth problems scale score (p = 0.061), all symptom scale scores were statistically significantly lower in Group A than in Group B (all p < 0.05) and in the late postoperative period, the speech, social eating, social contact, and coughing scale scores were statistically significantly lower (p = 0,0215, p = 0.021, p = 0.01, p = 0.011, respectively) in Group A than in Group B. HRQOL parameters recovered in the late postoperative period in both groups; recovery was better in Group A. DISCUSSION/CONCLUSION This study suggested that TORSGL may provide patients with a better HRQOL than those TCOSGL, especially in the early period, but also in the late period.
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Affiliation(s)
- Kamil Hakan Kaya
- Department of Otolaryngology Head and Neck Surgery, Health Science University, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Arzu Karaman Koç
- Department of Otolaryngology Head and Neck Surgery, Health Science University, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Fatma Tülin Kayhan
- Department of Otolaryngology Head and Neck Surgery, Health Science University, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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4
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Philips R, Topf MC, Vimawala S, Luginbuhl A, Curry JM, Cognetti DM. Risk factors for gastrostomy tube dependence in transoral robotic surgery patients. Am J Otolaryngol 2022; 43:103175. [PMID: 34418824 DOI: 10.1016/j.amjoto.2021.103175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/26/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. METHODS Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year. RESULTS A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28-28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37-41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis. CONCLUSIONS Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.
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Affiliation(s)
- Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA.
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232, USA
| | - Swar Vimawala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
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5
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Hilal L, Moukarbel R, Ollaik F, Yang P, Youssef B. Patient Selection for Surgery vs Radiotherapy for Early Stage Oropharyngeal Cancer. Cancer Control 2021; 28:10732748211050770. [PMID: 34936505 PMCID: PMC8704187 DOI: 10.1177/10732748211050770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Surgery and radiation therapy are both commonly used in the treatment of early stage (AJCC stages T1-T2 N0-M0) oropharyngeal squamous cell carcinoma (OPSCC). Transoral robotic surgery (TORS) and intensity modulated radiation therapy (IMRT) have been reported to result in similar survival and disease control outcomes. However, their side effect profiles widely differ. Nevertheless, patients who experience the worst side effects and quality of life are the ones who receive the combination of TORS and adjuvant radiation or chemoradiation therapy. Thus, appropriate patient selection for surgery to minimize the need for multimodality therapy is key. We propose, in this paper, the use of sentinel lymph node biopsy in the node negative (N0) neck as a means that is worth exploring for selecting patients to either radiation therapy or surgery. Patients with a positive sentinel lymph node (SLN) would be better directed to upfront radiation. On the contrary, patients with a negative SLN biopsy would be more confidently directed towards TORS and neck dissection alone.
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Affiliation(s)
- Lara Hilal
- Department of Radiation Oncology, 11238American University of Beirut, Beirut, Lebanon
| | - Roger Moukarbel
- Department of Head and Neck Surgery, 11238American University of Beirut, Beirut, Lebanon
| | - Farah Ollaik
- Department of Radiation Oncology, 11238American University of Beirut, Beirut, Lebanon
| | - Pei Yang
- 117924Hunan Cancer Center, Changsha, China
| | - Bassem Youssef
- Department of Radiation Oncology, 11238American University of Beirut, Beirut, Lebanon
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6
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Stephen SE, Murphy JM, Beyer FR, Sellstrom D, Paleri V, Patterson JM. Early postoperative functional outcomes following transoral surgery for oropharyngeal cancer: A systematic review. Head Neck 2021; 44:530-547. [PMID: 34882886 DOI: 10.1002/hed.26938] [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: 03/15/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available evidence for validated functional outcomes following TOS for OPC, within the early postoperative period. Key databases were searched. Primary TOS resections of human subjects were included. Validated functional outcomes extracted included instrumental assessment, clinician rated, and patient reported measures. Database searches yielded 7186 titles between 1990 and December 2020. Full-text articles were obtained for 296 eligible studies, which were screened and a resulting 14 studies, comprising 665 participants were included in the review. Oropharyngeal dysfunction following TOS was observed across all three categories of outcome measures (OMs) reported and was dependent on pretreatment function, T-classification, and tumor volume. Future investigations should include optimal OMs to be used in the postoperative setting to allow for conclusive comparisons.
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Affiliation(s)
- Sarah E Stephen
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jennifer M Murphy
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Diane Sellstrom
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Joanne M Patterson
- School of Health Sciences, Liverpool Head and Neck Cancer Centre, University of Liverpool, Liverpool, UK
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7
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Mehta MP, Prince R, Butt Z, Maxwell BE, Carnes BN, Patel UA, Stepan KO, Mittal BB, Samant S. Evaluating dysphagia and xerostomia outcomes following transoral robotic surgery for patients with oropharyngeal cancer. Head Neck 2021; 43:3955-3965. [PMID: 34617643 DOI: 10.1002/hed.26887] [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: 06/09/2021] [Revised: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We assessed long-term patient-reported dysphagia and xerostomia outcomes following definitive surgical management with transoral robotic surgery (TORS) in patients with oropharyngeal cancer (OPC) via a cross-sectional survey study. METHODS Patients with OPC managed with primary oropharyngeal surgery as definitive treatment at least 1 year ago between 2015 and 2019 were identified. The M. D. Anderson Dysphagia Inventory (MDADI) and Xerostomia Inventory (XI) scores were compared across treatment types (i.e., no adjuvant therapy [TORS-A] vs. adjuvant radiotherapy [TORS+RT] vs. adjuvant chemoradiotherapy [TORS+CT/RT]). RESULTS The sample had 62 patients (10 TORS-A, 30 TORS+RT, 22 TORS+CT/RT). TORS-A had clinically and statistically significantly better MDADI scores than TORS+RT (p = 0.03) and TORS+CT/RT (p = 0.02), but TORS+RT and TORS+CT/RT were not significantly different. TORS-A had clinically and statistically significantly less XI than TORS+RT (p < 0.01) and TORS+CT/RT (p < 0.01). CONCLUSIONS Patients with OPC who have undergone TORS+RT or TORS+CT/RT following surgery face clinically worse dysphagia and xerostomia outcomes relative to patients who undergo TORS-A.
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Affiliation(s)
- Mitesh P Mehta
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rebecca Prince
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bryce E Maxwell
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittni N Carnes
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet A Patel
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katelyn O Stepan
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bharat B Mittal
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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8
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Böhm F, Greve J, Riepl R, Hoffmann TK, Schuler PJ. [Robotics in otorhinolaryngology, head and neck surgery]. HNO 2021; 69:765-776. [PMID: 34272572 DOI: 10.1007/s00106-021-01088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
In many surgical specialities, e.g., visceral surgery or urology, the use of robotic assistance is widely regarded as standard for many interventions. By contrast, in European otorhinolaryngology, robotic-assisted surgery (RAS) is rarely conducted. This is because currently available robotic systems are not adequately adapted to the restricted space and partially difficult access to surgical fields in the head and neck area. Furthermore, RAS is associated with high costs at present. In some Anglo-American regions, robot-assisted surgery is already used regularly for different indications, particularly in transoral surgery of oropharyngeal tumors. Several feasibility studies demonstrate multiple fields of application for RAS in head and neck surgery. For standard use, the robotic systems and surgical instruments need to be reduced in size and adapted to application in the head and neck area.
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Affiliation(s)
- F Böhm
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland. .,Surgical Oncology Ulm, i2SOUL Konsortium, Ulm, Deutschland.
| | - J Greve
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.,Surgical Oncology Ulm, i2SOUL Konsortium, Ulm, Deutschland
| | - R Riepl
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.,Surgical Oncology Ulm, i2SOUL Konsortium, Ulm, Deutschland
| | - T K Hoffmann
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.,Surgical Oncology Ulm, i2SOUL Konsortium, Ulm, Deutschland
| | - P J Schuler
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.,Surgical Oncology Ulm, i2SOUL Konsortium, Ulm, Deutschland
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9
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Waltonen JD, Thomas SG, Russell GB, Sullivan CA. Oropharyngeal Carcinoma Treated with Surgery Alone: Outcomes and Predictors of Failure. Ann Otol Rhinol Laryngol 2021; 131:281-288. [PMID: 34056954 DOI: 10.1177/00034894211021287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the oncologic outcomes and risk factors for recurrence in patients who underwent surgery for oropharyngeal squamous cell carcinoma (OPSCC), and in whom adjuvant therapy was not recommended or was declined. METHODS Retrospective cohort study of patients with OPSCC who were treated with transoral surgery only at a tertiary care academic medical center from April 2010 to March 2019. RESULTS Seventy-four patients met inclusion criteria. In 16, adjuvant therapy was recommended but declined. There were 8 recurrences, of which 6 had been given recommendations for adjuvant therapy. Of the 8 recurrences, 2 died, 2 are alive with disease, and 4 were successfully salvaged. Five patients died of unrelated causes. Lymphovascular invasion (LVI, P = .016) had a significant impact on recurrence, while other pathologic features of the primary tumor such as size, location, human papillomavirus (HPV) status, and margin status did not. Margins were classified as "positive" in 4 patients, "close" in 54, and "negative" in 16. There were 3 local recurrences (4.1%), each of whom had declined adjuvant therapy. Lymph node features such as N-stage (P = .0004), number of positive nodes (P = .0005), and presence of extra-nodal extension (ENE, P = .0042) had a statistically significant impact on relapse. Smoking history and surgical approach showed no significant impact on recurrence. CONCLUSION Patients who undergo surgery for HPV-positive OPSCC with negative margins, no PNI, no LVI, and ≤1 positive lymph node without ENE have low risk for recurrence. These patients can likely be safely treated with surgery alone. Patients with these risk factors who decline adjuvant therapy are at risk for recurrence, and should be monitored.
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Affiliation(s)
- Joshua D Waltonen
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sydney G Thomas
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory B Russell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher A Sullivan
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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10
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Boehm F, Graesslin R, Theodoraki MN, Schild L, Greve J, Hoffmann TK, Schuler PJ. Current Advances in Robotics for Head and Neck Surgery-A Systematic Review. Cancers (Basel) 2021; 13:1398. [PMID: 33808621 PMCID: PMC8003460 DOI: 10.3390/cancers13061398] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background. In the past few years, surgical robots have recently entered the medical field, particularly in urology, gynecology, and general surgery. However, the clinical effectiveness and safety of robot-assisted surgery (RAS) in the field of head and neck surgery has not been clearly established. In this review, we evaluate to what extent RAS can potentially be applied in head and neck surgery, in which fields it is already daily routine and what advantages can be seen in comparison to conventional surgery. Data sources. For this purpose, we conducted a systematic review of trials published between 2000 and 2021, as well as currently ongoing trials registered in clinicaltrials.gov. The results were structured according to anatomical regions, for the topics "Costs," "current clinical trials," and "robotic research" we added separate sections for the sake of clarity. Results. Our findings show a lack of large-scale systematic randomized trials on the use of robots in head and neck surgery. Most studies include small case series or lack a control arm which enables a comparison with established standard procedures. Conclusion. The question of financial reimbursement is still not answered and the systems on the market still require some specific improvements for the use in head and neck surgery.
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Affiliation(s)
- Felix Boehm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
| | - Rene Graesslin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
| | - Marie-Nicole Theodoraki
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
| | - Leon Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
| | - Patrick J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, 89075 Ulm, Germany; (R.G.); (M.-N.T.); (L.S.); (J.G.); (T.K.H.)
- Surgical Oncology Ulm, i2SOUL Consortium, 89075 Ulm, Germany
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11
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Abstract
Robot-assisted surgery (RAS) has already been approved for several clinical applications in head and neck surgery. In some Anglo-American regions, RAS is currently the common standard for treatment of oropharyngeal diseases. Systematic randomized studies comparing established surgical procedures with RAS in a large number of patients are unavailable so far. Experimental publications rather describe how to reach poorly accessible anatomical regions using RAS, or represent feasibility studies on the use of transoral robotic surgery (TORS) in established surgical operations. With general application of RAS in clinical practice, the question of financial reimbursement arises. Furthermore, the technical applications currently on the market still require some specific improvements for routine use in head and neck surgery.
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12
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Modelling Autonomous Agents’ Decisions in Learning to Cross a Cellular Automaton-Based Highway via Artificial Neural Networks. COMPUTATION 2020. [DOI: 10.3390/computation8030064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A lot of effort has been devoted to mathematical modelling and simulation of complex systems for a better understanding of their dynamics and control. Modelling and analysis of computer simulations outcomes are also important aspects of studying the behaviour of complex systems. It often involves the use of both traditional and modern statistical approaches, including multiple linear regression, generalized linear model and non-linear regression models such as artificial neural networks. In this work, we first conduct a simulation study of the agents’ decisions learning to cross a cellular automaton based highway and then, we model the simulation data using artificial neural networks. Our research shows that artificial neural networks are capable of capturing the functional relationships between input and output variables of our simulation experiments, and they outperform the classical modelling approaches. The variable importance measure techniques can consistently identify the most dominant factors that affect the response variables, which help us to better understand how the decision-making by the autonomous agents is affected by the input factors. The significance of this work is in extending the investigations of complex systems from mathematical modelling and computer simulations to the analysis and modelling of the data obtained from the simulations using advanced statistical models.
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13
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Lin C, Kang SY, Donermeyer S, Teknos TN, Wells-Di Gregorio SM. Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine. Otolaryngol Head Neck Surg 2020; 163:356-363. [PMID: 32178571 DOI: 10.1177/0194599820912029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology. STUDY DESIGN Case series with planned data collection. SETTING Academic quaternary care center. SUBJECTS AND METHODS We provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality-of-life screening, from patients' first encounter at outpatient palliative medicine. RESULTS HNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1-54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty-three percent of patients had no evidence of disease. Seventy-five percent had a psychological history based on DSM-IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality-of-life concerns were pain, housing and financial problems, and xerostomia. CONCLUSIONS Patients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer-specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end-of-life care.
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Affiliation(s)
- Chen Lin
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Samantha Donermeyer
- Department of Psychiatry and James Psychosocial Oncology, The Ohio State University, Columbus, Ohio
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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14
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Systematic Review of Validated Quality of Life and Swallow Outcomes after Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2019; 161:561-567. [DOI: 10.1177/0194599819844755] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the available evidence on the effects of transoral robotic surgery (TORS) on the posttreatment quality of life (QOL) and swallow function of patients with head and neck cancer. Data Sources PubMed and Ovid electronic databases were searched from inception to July 6, 2016. Specific database functions were applied to maximize the search. Review Methods Articles in the database were reviewed for inclusion by 2 independent reviewers according to predetermined eligibility criteria. The references of relevant articles were then hand-searched to identify additional manuscripts. For included articles, the study characteristics and relevant data were extracted. Results Of 103 articles screened, 20 reporting validated measures of QOL and/or swallow outcomes for 659 patients were eligible for inclusion. Fourteen were observational studies or case series and did not compare the TORS group with another intervention. Two were prospective nonrandomized clinical trials that compared outcomes between TORS and primary chemoradiation. Four were cohort studies comparing TORS with other treatment approaches and modalities, including open surgical approaches and transoral laser microsurgery. Overall, most patients who underwent TORS ± adjuvant therapy reported a return to baseline QOL and swallow function by 6 to 12 months posttreatment. Several studies demonstrated superior QOL and swallowing outcomes when compared with primary chemoradiation or open approaches. Conclusions Available evidence suggests that patients who undergo TORS for head and neck cancer have good QOL and swallowing outcomes after treatment, but outcomes are dependent on baseline function, T stage, and adjuvant treatment status.
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15
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Gallitto M, Sindhu K, Wasserman I, De B, Gupta V, Miles BA, Genden EM, Posner M, Misiukiewicz K, Bakst RL. Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit? Head Neck 2019; 41:3009-3022. [DOI: 10.1002/hed.25779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew Gallitto
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Kunal Sindhu
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Isaac Wasserman
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Brian De
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Vishal Gupta
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Brett A. Miles
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Eric M. Genden
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Marshall Posner
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Richard L. Bakst
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
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16
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Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: A comparative analysis of a prospective registry. Oral Oncol 2019; 91:13-20. [DOI: 10.1016/j.oraloncology.2019.01.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/22/2022]
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17
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Pearlstein KA, Wang K, Amdur RJ, Shen CJ, Dagan R, Weiss J, Grilley-Olson JE, Zanation A, Hackman TG, Thorp BD, Blumberg JM, Patel S, Sheets N, Weissler MC, Mendenhall WM, Chera BS. Quality of Life for Patients With Favorable-Risk HPV-Associated Oropharyngeal Cancer After De-intensified Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2019; 103:646-653. [DOI: 10.1016/j.ijrobp.2018.10.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/24/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
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18
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Bollig CA, Jorgensen JB. Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer. Head Neck 2019; 41:892-898. [DOI: 10.1002/hed.25482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/05/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
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19
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Tam K, Orosco RK, Dimitrios Colevas A, Bedi N, Starmer HM, Beadle BM, Christopher Holsinger F. Cost comparison of treatment for oropharyngeal carcinoma. Laryngoscope 2018; 129:1604-1609. [DOI: 10.1002/lary.27544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Kenric Tam
- Department of Otolaryngology, Division of Head and Neck Surgery; Stanford University School of Medicine; Palo Alto California U.S.A
| | - Ryan K. Orosco
- Department of Otolaryngology, Division of Head and Neck Surgery; Stanford University School of Medicine; Palo Alto California U.S.A
| | - A. Dimitrios Colevas
- Department of Medicine, Division of Oncology; Stanford University School of Medicine; Palo Alto California U.S.A
| | - Nikita Bedi
- Department of Otolaryngology, Division of Head and Neck Surgery; Stanford University School of Medicine; Palo Alto California U.S.A
| | - Heather M. Starmer
- Department of Otolaryngology, Division of Head and Neck Surgery; Stanford University School of Medicine; Palo Alto California U.S.A
| | - Beth M. Beadle
- Department of Radiation Oncology; Stanford University School of Medicine; Palo Alto California U.S.A
| | - F. Christopher Holsinger
- Department of Otolaryngology, Division of Head and Neck Surgery; Stanford University School of Medicine; Palo Alto California U.S.A
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20
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Gobillot TA, Kaka AS, Patel SA, Rodriguez C, Cannon RB, Futran ND, Houlton JJ. Treatment of Tonsillar Carcinoma following Nononcologic Tonsillectomy: Efficacy of Transoral Robotic Revision Tonsillectomy. Otolaryngol Head Neck Surg 2018; 160:627-634. [PMID: 30274541 DOI: 10.1177/0194599818802185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate whether transoral robotic surgery (TORS) is a suitable treatment approach for patients diagnosed with tonsillar carcinoma after a standard palatine tonsillectomy. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care medical center. SUBJECTS AND METHODS Patients who underwent TORS at the University of Washington from 2010 to 2017 (n = 150) were identified. All patients who were diagnosed with tonsillar carcinoma following a nononcologic tonsillectomy and subsequently underwent TORS radical tonsillectomy were included (n = 14). Tumor stage-matched subjects (n = 44) were included who did not undergo standard tonsillectomy prior to TORS. Our primary outcome was final margin status. Secondary outcomes were presence of residual tumor, receipt and dose of postoperative adjuvant therapy, disease-free survival (DFS), and disease-specific survival. Patients with <6 months of follow-up following definitive treatment were excluded from survival analyses. RESULTS Final margin status was clear in all subjects. Residual tumor was not identified in 13 of 14 (92.9%) prior-tonsillectomy subjects following TORS radical tonsillectomy. Seven of 14 (50%) prior-tonsillectomy subjects and 12 of 44 (27.3%) TORS-matched subjects did not require adjuvant therapy due to favorable pathology. Among subjects who received post-TORS radiation therapy (RT) at our institution, RT dose reduction was achieved in 3 of 4 (75%) prior-tonsillectomy subjects and 21 of 24 (87.5%) TORS-matched subjects. Ten of 14 (71.4%) prior-tonsillectomy subjects and 31 of 44 (70.5%) TORS-matched subjects avoided post-TORS chemotherapy. DFS was not significantly different ( P = .87) between prior-tonsillectomy and TORS-matched groups, and no subjects died of related disease. CONCLUSIONS Patients diagnosed with tonsillar carcinoma following a prior nononcologic standard palatine tonsillectomy are suitable candidates for revision surgery with TORS radical tonsillectomy.
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Affiliation(s)
- Theodore A Gobillot
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Azeem S Kaka
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Sapna A Patel
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Cristina Rodriguez
- 2 Department of Medicine, Division of Oncology, University of Washington, Seattle, Washington, USA
| | - Richard B Cannon
- 3 Department of Surgery, Division of Otolaryngology-Head and Neck Surgery (R.B.C.), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Neal D Futran
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey J Houlton
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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21
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pN status predicts outcomes in surgically treated pT1-pT2 patients of various disease stages with squamous cell carcinoma of the head and neck: a 17-year retrospective single center cohort study. Eur Arch Otorhinolaryngol 2018; 275:2787-2795. [PMID: 30159726 DOI: 10.1007/s00405-018-5108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The optimal treatment for a substantial proportion of patients with pT1-pT2 squamous cell carcinomas of the head and neck (SCCHN) remains to be refined. The extent of surgery, role and potential benefit of adjuvant treatment are to be balanced against therapy-induced side effects. We compared the outcomes of surgery with or without adjuvant radiotherapy (RT) or chemotherapy (CRT) and investigated the prognostic value of established clinicopathological parameters. METHODS Data were retrospectively collected for 227 patients who were treated by surgery alone (n = 31), RT (n = 87) and CRT (n = 109) in a single center. RESULTS Patients with stage I/II disease who had received adjuvant RT showed a better disease-free survival (DFS) (P = 0.04) than those who had received adjuvant CRT treatment. Conversely, patients with stage III/IV disease who had received CRT showed a better overall survival (OS) (P = 0.003) and DFS (P = 0.03) than those who had received surgery alone or adjuvant RT without chemotherapy. Survival analysis demonstrated that patients with pN0 to pN1 had better OS (P = 0.02), disease-specific survival (DSS) (P = 0.003), DFS (P = 0.02) and metastases free survival (MFS) (P = 0.002) compared to patients with pN2 to pN3. Multivariate analysis showed that the pN status was an independent factor for OS (P = 0.03), DSS (P = 0.04), relapse-free survival (P = 0.03), DFS (P = 0.03). CONCLUSION The pN status is the most important prognostic factor for pT1 to pT2 SCCHN. Adjuvant CRT was associated with significantly better survival outcomes in patients with pN1 and pN2-3 or more advanced stage, while adjuvant RT showed significantly better outcomes in patients with pN0.
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22
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Heah H, Goepfert RP, Hutcheson KA, Garden AS, Gunn GB, Fuller CD, Lewin JS, Kupferman ME, Holsinger FC, Hessel AC, Gross ND. Decreased gastrostomy tube incidence and weight loss after transoral robotic surgery for low- to intermediate-risk oropharyngeal squamous cell carcinoma. Head Neck 2018; 40:2507-2513. [DOI: 10.1002/hed.25382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/29/2018] [Accepted: 05/28/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Harold Heah
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Otolaryngology; Singapore General Hospital; Singapore
| | - Ryan P. Goepfert
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Adam S. Garden
- Department of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - G. Brandon Gunn
- Department of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Clifton D. Fuller
- Department of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jan S. Lewin
- Department of Otolaryngology; Singapore General Hospital; Singapore
| | - Michael E. Kupferman
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - F. Christopher Holsinger
- Department of Otolaryngology - Head and Neck Surgery; Stanford University Medical Center; Stanford California
| | - Amy C. Hessel
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Neil D. Gross
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
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23
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Rock K, O’Sullivan B, Chen ZJ, Xu ZY, Li JS, Huang SH. Surgery- vs Radiation-Based Therapy for p16+/HPV-Related Oropharyngeal Cancers. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0214-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Friedrich D, Modes V, Hoffmann T, Greve J, Schuler P, Burgner-Kahrs J. Teleoperated tubular continuum robots for transoral surgery - feasibility in a porcine larynx model. Int J Med Robot 2018; 14:e1928. [DOI: 10.1002/rcs.1928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- D.T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - V. Modes
- Laboratory for Continuum Robotics; Leibniz Universität Hannover; Hanover Germany
| | - T.K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - J. Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - P.J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - J. Burgner-Kahrs
- Laboratory for Continuum Robotics; Leibniz Universität Hannover; Hanover Germany
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25
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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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26
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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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27
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Identification of Malignancy-Associated Changes in Histologically Normal Tumor-Adjacent Epithelium of Patients with HPV-Positive Oropharyngeal Cancer. Anal Cell Pathol (Amst) 2018; 2018:1607814. [PMID: 29713583 PMCID: PMC5866869 DOI: 10.1155/2018/1607814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/28/2022] Open
Abstract
The incidence of HPV-positive oropharyngeal cancer (HPV+ OPC) is increasing, thus presenting new challenges for disease detection and management. Noninvasive methods involving brush biopsies of diseased tissues were recently reported as insufficient for tumor detection in HPV+ OPC patients, likely due to differences between the site of tumor initiation at the base of involuted crypts and the site of brush biopsy at the crypt surface. We hypothesized that histologically normal surface epithelial cells in the oropharynx contain changes in nuclear morphology that arise due to tumor proximity. We analyzed the nuclear phenotype of matched tumor, tumor-adjacent normal, and contralateral normal tissues from biopsies of nine HPV+ OPC patients. Measurements of 89 nuclear features were used to train a random forest-based classifier to discriminate between normal and tumor nuclei. We then extracted voting scores from the trained classifier, which classify nuclei on a continuous scale from zero (“normal-like”) to one (“tumor-like”). In each case, the average score of the adjacent normal nuclei was intermediate between the tumor and contralateral normal nuclei. These results provide evidence for the existence of phenotypic changes in histologically normal, tumor-adjacent surface epithelial cells, which could be used as brush biopsy-based biomarkers for HPV+ OPC detection.
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28
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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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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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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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Nehme J, Neville JJ, Bahsoun AN. The use of robotics in plastic and reconstructive surgery: A systematic review. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Dziegielewski PT, Boyce BJ, Old M, Teknos TN, Agrawal A, Patwa H, Ozer E. Transoral robotic surgery for tonsillar cancer: Addressing the contralateral tonsil. Head Neck 2017; 39:2224-2231. [DOI: 10.1002/hed.24887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/21/2017] [Accepted: 06/15/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Peter T. Dziegielewski
- Department of Otolaryngology; University of Florida; Gainesville Florida
- University of Florida Health Cancer Center; University of Florida; Gainesville Florida
| | - Brian J. Boyce
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Matthew Old
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| | - Theodoros N. Teknos
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
| | - Hafiz Patwa
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
- Comprehensive Cancer Center; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Columbus Ohio
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Sethia R, Yumusakhuylu AC, Ozbay I, Diavolitsis V, Brown NV, Zhao S, Wei L, Old M, Agrawal A, Teknos TN, Ozer E. Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer. Laryngoscope 2017; 128:403-411. [PMID: 28771728 DOI: 10.1002/lary.26796] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare quality of life (QOL) of patients who underwent transoral robotic surgery (TORS) alone, with adjuvant radiation therapy (RT), or adjuvant chemoradiation therapy (CRT) in the treatment of oropharyngeal squamous cell cancer (OPSCCA). STUDY DESIGN Prospective cohort study. METHODS Medical records were reviewed for 111 patients treated for OPSCCA from 2008 to 2015. Patients were administered the Head and Neck Cancer Inventory (HNCI) to evaluate QOL preoperatively, and at 3 weeks, 3 months, 6 months, and 1 year postsurgery. QOL data were compared between 13 patients treated with TORS alone, 31 with adjuvant RT, and 67 with adjuvant CRT by a linear mixed effects model. RESULTS Mean follow-up was 35 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 80%, 60%, 55%, and 46%, respectively. TORS alone reported significantly higher eating scores than adjuvant RT or CRT at 3 and 6 months, and higher speech scores compared to adjuvant CRT at 3 months and adjuvant RT at 6 months. TORS alone and adjuvant RT reported less social disruption compared to adjuvant CRT at 3 months. Adjuvant CRT had consistently lower overall QOL scores until 6 months. No TORS-alone patient required percutaneous endoscopic gastrostomy, and no study patient required tracheostomy during treatment. CONCLUSIONS TORS alone maintained higher QOL than adjuvant RT or CRT in eating, social function, speech, and overall QOL postsurgery. QOL and functional metrics were better for 6 months in TORS-alone patients, and at 12 months, the differences were not significant. LEVEL OF EVIDENCE 4. Laryngoscope, 128:403-411, 2018.
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Affiliation(s)
- Rishabh Sethia
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Ali C Yumusakhuylu
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Isa Ozbay
- Department of Otolaryngology, Dumlupinar University, Kutahya, Turkey.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Virginia Diavolitsis
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Nicole V Brown
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Songzhu Zhao
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
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Sharma A, Patel S, Baik FM, Mathison G, Pierce BHG, Khariwala SS, Yueh B, Schwartz SM, Méndez E. Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy. JAMA Otolaryngol Head Neck Surg 2017; 142:691-7. [PMID: 27347780 DOI: 10.1001/jamaoto.2016.1106] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Treatment of oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and can be associated with significant morbidity. Transoral robotic surgery (TORS) has emerged as a treatment modality for OPSCC, but data comparing outcomes between patients treated with TORS-based therapy and nonsurgical therapy are limited. OBJECTIVE To compare survival and gastrostomy prevalence between patients with OPSCC treated with TORS-based therapy and those treated with nonsurgical therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched-cohort study identified patients with OPSCC treated at the University of Washington and University of Minnesota tertiary care medical centers from January 1, 2005, to December 31, 2013. Each patient treated with TORS-based therapy was matched by stage with as many as 3 patients treated with nonsurgical therapy. Final follow-up was completed on April 1, 2015. MAIN OUTCOMES AND MEASURES Disease-free survival, overall survival, and gastrostomy tube prevalence. RESULTS One hundred twenty-seven patients met the study criteria (113 men [89.0%]; 14 women [11.0%]; median [interquartile range] age, 57 [52-63] years); 39 patients who underwent TORS were matched to 88 patients who underwent nonsurgical therapy. Compared with the nonsurgical group, more patients had p16-positive tumors in the TORS group (30 of 31 [96.8%] vs 30 of 37 [81.1%] among patients with known p16 status). No statistically significant difference in survival between treatment groups was found in multivariable analysis (disease-free survival hazard ratio, 0.22; 95% CI, 0.04-1.36; P = .10). Patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (13 of 39 [33.3%] vs 74 of 88 [84.1%]) for a univariable relative risk of 0.43 (95% CI, 0.27-0.67; P < .001) and a multivariable relative risk of 0.43 (95% CI, 0.27-0.68; P < .001). Gastrostomy prevalence decreased by time after treatment for both groups (TORS group: 3 of 34 [9%] at 3 months to 1 of 33 [3%] at 12 months; nonsurgical group: 37 of 82 [45%] at 3 months to 7 of 66 [11%] at 12 months). CONCLUSIONS AND RELEVANCE Patients undergoing TORS for OPSCC have statistically indistinguishable survival but lower gastrostomy prevalence compared with patients undergoing nonsurgical therapy for stage-matched OPSCC. TORS offers promise for improved swallowing function in patients with OPSCC.
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Affiliation(s)
- Arun Sharma
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Sapna Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Fred M Baik
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Grant Mathison
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Brendan H G Pierce
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Bevan Yueh
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Stephen M Schwartz
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington5Department of Epidemiology, University of Washington, Seattle
| | - Eduardo Méndez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle6Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Liu HH, Li LJ, Shi B, Xu CW, Luo E. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci 2017; 9:63-73. [PMID: 28660906 PMCID: PMC5518975 DOI: 10.1038/ijos.2017.24] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
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Affiliation(s)
- Hang-Hang Liu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Long-Jiang Li
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Bin Shi
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Chun-Wei Xu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - En Luo
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
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Ozbay I, Yumusakhuylu AC, Sethia R, Wei L, Old M, Agrawal A, Teknos T, Ozer E. One-year quality of life and functional outcomes of transoral robotic surgery for carcinoma of unknown primary. Head Neck 2017; 39:1596-1602. [PMID: 28513895 DOI: 10.1002/hed.24801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 02/08/2017] [Accepted: 02/23/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the quality of life (QOL) outcomes in patients who underwent transoral robotic surgery (TORS) for carcinoma of unknown primary (CUP). METHODS Twenty-nine patients with CUP were administered the Head and Neck Cancer Inventory (HNCI) prospectively to evaluate QOL preoperatively and postoperatively. RESULTS There was statistically and clinically significant deterioration in 2 of 4 domains (eating and social disruption) in the immediate aftermath of TORS. There was statistically and clinically meaningful deterioration in all 4 domains at 3 months relative to baseline, and there remained statistically and clinically meaningful deterioration in 2 of 4 domains at 6 months compared to baseline. These 2 domains remained statistically and clinically worse than baseline at 12 months. Speech and aesthetics domain scores were comparable at baseline and 12 months. CONCLUSION Patients reported difficulties with eating and social disruption over the course of 1 year, but problems with speech and appearance abated.
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Affiliation(s)
- Isa Ozbay
- Department of Otolaryngology, Dumlupinar University, Kutahya, Turkey.,Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ali Cemal Yumusakhuylu
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Otolaryngology, Marmara University, Istanbul, Turkey
| | - Rishabh Sethia
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Lai Wei
- Department of Biomedical, The Ohio State University, Columbus, Ohio
| | - Matthew Old
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Theodoros Teknos
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, "Arthur G. James" Cancer Hospital and "Richard J. Solove" Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
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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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Funk E, Goldenberg D, Goyal N. Demonstration of transoral robotic supraglottic laryngectomy and total laryngectomy in cadaveric specimens using the Medrobotics Flex System. Head Neck 2017; 39:1218-1225. [PMID: 28301093 DOI: 10.1002/hed.24746] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/19/2016] [Accepted: 01/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current management of laryngeal malignancies is associated with significant morbidity. Application of minimally invasive transoral techniques may reduce the morbidity associated with traditional procedures. The purpose of this study was to present our investigation of the utility of a novel flexible robotic system for transoral supraglottic laryngectomy and total laryngectomy. METHODS Transoral total laryngectomy and transoral supraglottic laryngectomy were performed in cadaveric specimens using the Flex Robotic System (Medrobotics, Raynham, MA). RESULTS All procedures were completed successfully in the cadaveric models. The articulated endoscope allowed for access to the desired surgical site. Flexible instruments enabled an atraumatic approach and allowed for precise surgical technique. CONCLUSION Access to deep anatomic structures remains problematic using current minimally invasive robotic approaches. Improvements in visualization and access to the laryngopharyngeal complex offered by this system may improve surgical applications to the larynx. This study demonstrates the technical feasibility using the Flex Robotic System for transoral robotic supraglottic laryngectomy and total laryngectomy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1218-1225, 2017.
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Affiliation(s)
- Emily Funk
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Neerav Goyal
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Oncologic outcomes and patient-reported quality of life in patients with oropharyngeal squamous cell carcinoma treated with definitive transoral robotic surgery versus definitive chemoradiation. Oral Oncol 2016; 61:41-6. [PMID: 27688103 DOI: 10.1016/j.oraloncology.2016.08.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/29/2016] [Accepted: 08/17/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE It has been postulated that treatment outcomes are similar between transoral robotic surgery (TORS) and definitive chemoradiation (CRT) for oropharyngeal squamous cell carcinomas (OPSCC). We compared oncologic and quality of life (QOL) outcomes between definitive CRT and definitive TORS. MATERIALS AND METHODS An observational comparison study was performed on 92 patients treated with TORS±adjuvant therapy and 46 patients treated with definitive CRT between July 2005 and January 2016. The Kaplan Meier method was used for survival analyses, and the Mann-Whitney test was used to compare QOL scores between groups. RESULTS All patients had T0-T2 and N0-N2 disease, although CRT patients had higher clinical staging (p<0.001). HPV+ disease was present in 79% (n=73) of TORS patients and 91% (n=19) of tested CRT patients. Median follow-up was 22.1months (range: 0.33-83.4). There were no significant differences in locoregional control or overall survival between CRT and TORS groups. Definitive TORS resulted in better saliva-related QOL than definitive CRT at 1, 6, 12, and 24months (p<0.001, p=0.025, p=0.017, p=0.011). Among TORS patients, adjuvant therapy was associated with worse QOL in the saliva domain at 6, 12, and 24months (p<0.001, p<0.001, p=0.007), and taste domain at 6 and 12months (p=0.067, p=0.008). CONCLUSION Definitive CRT and definitive TORS offer similar rates of locoregional control, overall survival, and disease-free survival in patients with early stage OPSCC. TORS resulted in significantly better short and long-term saliva-related QOL, whereas adjuvant therapy was associated with worse saliva and taste-related QOL compared to TORS alone.
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Sload R, Silver N, Jawad BA, Gross ND. The Role of Transoral Robotic Surgery in the Management of HPV Negative Oropharyngeal Squamous Cell Carcinoma. Curr Oncol Rep 2016; 18:53. [DOI: 10.1007/s11912-016-0541-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bekeny JR, Ozer E. Transoral robotic surgery frontiers. World J Otorhinolaryngol Head Neck Surg 2016; 2:130-135. [PMID: 29204557 PMCID: PMC5698526 DOI: 10.1016/j.wjorl.2016.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 10/30/2022] Open
Abstract
Transoral robotic surgery is a exciting field that continues to develop and push the boundaries of current procedural ability and challenges historical treatment paradigms. With the first use of a surgical robot in 1985, to the first clinical use of the robot transorally in 2005, there was some lag in adoption of robotic techniques in the head and neck region. However, since 2005 transoral robotic surgery has rapidly gained momentum amongst head and neck surgeons. With FDA approval of the da Vinci robot in 2009, transoral robotic surgery is currently offered as a treatment modality for malignant and nonmalignant disease of the head and neck region. This new technology is being used to reconsider historical treatment paradigms for malignancies of the upper aerodigestive tract due to the fact that minimally invasive surgical access to the oropharynx and larynx has been improved. Along with this enhanced access have come innovative procedures and uses of the technology for multiple facets of head and neck disease. Technology continues to improve and innovation in surgical robotics is expected to continue as more companies attempt to capture this market. This article aims to provide a view at the landscape of transoral robotic surgery and explore the future frontiers.
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Affiliation(s)
- James R Bekeny
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, The James Cancer Hospital and Solove Research Institute, Columbus, OH 43210, USA
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, The James Cancer Hospital and Solove Research Institute, Columbus, OH 43210, USA
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O'Leary P, Kjærgaard T. Transoral robotic surgery and oropharyngeal cancer: a literature review. EAR, NOSE & THROAT JOURNAL 2016; 93:E14-21. [PMID: 25181669 DOI: 10.1177/014556131409300821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of head and neck squamous cell carcinoma has risen steadily over the past decade due to the increase in cancers associated with the human papillomavirus (HPV). The prognosis for the treatment of this type of cancer with radiotherapy and chemoradiotherapy is good. However, because these treatments can have detrimental effects on organ function and quality of life, researchers are looking into transoral robotic surgery (TORS) as a possible alternate therapy. TORS might have a positive effect on postoperative function and quality of life for cancer survivors. The aim of this review is to report on the current situation regarding the treatment of oropharyngeal cancer with TORS, with a focus on the long-term oncologic and functional outcomes of this strategy. The articles cited in this review were selected from the PubMed and MEDLINE database. They contain study results pertaining to TORS implementation, complications, oncologic and functional outcomes, and the implications of HPV-associated cancer. We found that while TORS has some clear advantages and strengths and almost certainly a permanent place in future treatment, further research is necessary to correctly evaluate the role it will play in the complete management of oropharyngeal cancer.
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Affiliation(s)
- Pádraig O'Leary
- Department of Otorhinolaryngology-Head and Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, Byg. 10, 1. Sal., 8000 Aarhus C, Denmark.
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Rogers SN, Pinto RS, Lancaster J, Bekiroglu F, Lowe D, Tandon S, Jones TM. Health related quality of life following the treatment of oropharyngeal cancer by transoral laser. Eur Arch Otorhinolaryngol 2016; 273:3913-3920. [DOI: 10.1007/s00405-016-4035-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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Friedrich DT, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ. Recent advances in robot-assisted head and neck surgery. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1744] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/12/2016] [Accepted: 02/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Marc O. Scheithauer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Thomas K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Patrick J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
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Dawe N, Patterson J, O'Hara J. Functional swallowing outcomes following treatment for oropharyngeal carcinoma: a systematic review of the evidence comparing trans-oral surgeryversusnon-surgical management. Clin Otolaryngol 2016; 41:371-85. [DOI: 10.1111/coa.12526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 01/22/2023]
Affiliation(s)
- N. Dawe
- Northern Deanery Otolaryngology Specialist Training; Newcastle upon Tyne UK
| | - J. Patterson
- Department of Speech and Language Therapy; City Hospitals Sunderland; Newcastle upon Tyne UK
- Institute for Health and Society; Newcastle University; Newcastle upon Tyne UK
| | - J. O'Hara
- Institute for Health and Society; Newcastle University; Newcastle upon Tyne UK
- Department of Otolaryngology - Head and Neck Surgery; The Freeman Hospital; Newcastle upon Tyne UK
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Kumar B, Cipolla MJ, Old MO, Brown NV, Kang SY, Dziegielewski PT, Durmus K, Ozer E, Agrawal A, Carrau RL, Schuller DE, Leon ME, Pan Q, Kumar P, Wood V, Burgers J, Wakely PE, Teknos TN. Surgical management of oropharyngeal squamous cell carcinoma: Survival and functional outcomes. Head Neck 2015; 38 Suppl 1:E1794-802. [PMID: 26694981 DOI: 10.1002/hed.24319] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to further define the impact of primary surgery in the management of oropharyngeal squamous cell carcinoma (SCC). METHODS Two hundred ninety-six patients with oropharyngeal SCC treated with primary surgery were included. Multivariable analysis and recursive partitioning analysis (RPA) identified predictors of survival and gastrostomy tube presence. RESULTS Multivariable analysis identified that HPV negativity (p = .0002), presence of extranodal extension (p = .0025), and advanced T classification (p = .0081) were independent predictors of survival. For HPV-positive patients, surgical approach (p = .0111) and margin status (p = .0287) were significant predictors of survival. For HPV-negative patients, extranodal extension (p = .0021) and advanced T classification (p = .0342) were significant predictors of survival. Smoking status and advanced neck disease did not impact survival, and the addition of adjuvant chemotherapy did not confer survival benefit in HPV-positive or HPV-negative subgroups. CONCLUSION Independent predictors of survival are unique in patients with oropharyngeal SCC treated with primary surgery. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1794-E1802, 2016.
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Affiliation(s)
- Bhavna Kumar
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael J Cipolla
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicole V Brown
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter T Dziegielewski
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kasim Durmus
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David E Schuller
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Marino E Leon
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Quintin Pan
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Pawan Kumar
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Valerie Wood
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jessica Burgers
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul E Wakely
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Theodoros N Teknos
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Buckley L, Gupta R, Ashford B, Jabbour J, Clark JR. Oropharyngeal cancer and human papilloma virus: evolving diagnostic and management paradigms. ANZ J Surg 2015; 86:442-7. [DOI: 10.1111/ans.13417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Lisa Buckley
- Graduate School of Medicine; University of Wollongong; Wollongong New South Wales Australia
| | - Ruta Gupta
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Bruce Ashford
- Illawarra Health and Medical Research Institute; Wollongong New South Wales Australia
| | - Joe Jabbour
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales; Sydney New South Wales Australia
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Walliczek U, Förtsch A, Dworschak P, Teymoortash A, Mandapathil M, Werner J, Güldner C. Effect of training frequency on the learning curve on the da Vinci Skills Simulator. Head Neck 2015; 38 Suppl 1:E1762-9. [PMID: 26681572 DOI: 10.1002/hed.24312] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/19/2015] [Accepted: 09/20/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of training on the performance outcome with the da Vinci Skills Simulator. METHODS Forty novices were enrolled in a prospective training curriculum. Participants were separated into 2 groups. Group 1 performed 4 training sessions and group 2 had 2 training sessions over a 4-week period. Five exercises were performed 3 times consecutively. On the last training day, a new exercise was added. RESULTS A significant skills gain from the first to the final practice day in overall performance, time to complete, and economy of motion was seen for both groups. Group 1 had a significantly better outcome in overall performance, time to complete, and economy of motion in all exercises. There was no significant difference found regarding the new exercise in group 1 versus group 2 in nearly all parameters. CONCLUSION Longer time distances between training sessions are assumed to play a secondary role, whereas total repetition frequency is crucial for improvement of technical performance. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1762-E1769, 2016.
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Affiliation(s)
- Ute Walliczek
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - Arne Förtsch
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - Philipp Dworschak
- Department of Orthopedics, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - Afshin Teymoortash
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - Magis Mandapathil
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - Jochen Werner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - Christian Güldner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
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Lim GC, Holsinger FC, Li RJ. Transoral Endoscopic Head and Neck Surgery: The Contemporary Treatment of Head and Neck Cancer. Hematol Oncol Clin North Am 2015; 29:1075-92. [PMID: 26568549 DOI: 10.1016/j.hoc.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traditional open surgical approaches are indicated for treatment of select tumor subsites of head and neck cancer, but can also result in major cosmetic and functional morbidity. Transoral surgical approaches have been used for head and neck cancer since the 1960s, with their application continuing to evolve with the changing landscape of this disease and recent innovations in surgical instrumentation. The potential to further reduce treatment morbidity with transoral surgery, while optimizing oncologic outcomes, continues to be investigated. This review examines current literature evaluating oncologic and quality-of-life outcomes achieved through transoral head and neck surgery.
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Affiliation(s)
- Gil Chai Lim
- Department of Otolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, 102 Jejudaehak-ro, Jeju Special Self-Governing Province 63243, Republic of Korea
| | - Floyd Christopher Holsinger
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305-5820, USA
| | - Ryan J Li
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305-5820, USA.
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