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Ansarin M, Pietrobon G, Tagliabue M, Mossinelli C, Ruju F, Maffini F, Rocca MC, Alterio D, Simon C, Zorzi SF. Salvage transoral robotic surgery in recurrent oropharyngeal carcinoma: a single-center retrospective study. Eur Arch Otorhinolaryngol 2024; 281:3167-3177. [PMID: 38546850 DOI: 10.1007/s00405-024-08590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Salvage surgery is still the best therapeutic option for resectable recurrent oropharyngeal squamous cell carcinoma (rOPSCC). Transoral robotic surgery may potentially reduce the morbidity of standard open approaches. The aim of the study is to present oncological and functional outcomes of a monocentric experience in salvage transoral robotic surgery. METHODS We performed a single-center retrospective analysis of patients submitted to transoral robotic salvage surgery with or without neck dissection for cT1-3 rOPSCC. We investigated complication rate, survival outcomes (Overall Survival, Disease Specific Survival, Loco-Regional Recurrence Free Survival) and functional outcomes (tracheal tube and/or gastrostomy dependence). RESULTS Sixty-one patients were included in the analysis. No major complications or perioperative deaths were recorded. The estimated 2-year OS was 76.7%, DSS 81.8% and LRRFS 50.5%. In multivariable analysis rpT, PNI (perineural infiltration) and HPV-positivity were significantly associated with LRRFS (Hazard Ratios: T3 vs T1 6.43, PNI yes vs no 4.19, HPV+ yes vs no 2.63). At last follow up, 97% of patients were tracheal tube-free, while 93% were gastrostomy-free. CONCLUSION Transoral robotic salvage surgery is a successful treatment in selected patients affected by rOPSCC because it grants good oncologic and functional outcomes.
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Affiliation(s)
- Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Chiara Mossinelli
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Francesca Ruju
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Division of Medical Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
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Müderris T, Sevil E, Gül F. Transoral robotic supraglottic laryngectomy: Long-term functional and oncologic outcomes. Am J Otolaryngol 2024; 45:104105. [PMID: 37977058 DOI: 10.1016/j.amjoto.2023.104105] [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: 07/23/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Minimally invasive transoral organ preservation surgeries are being increasingly used for supraglottic tumors. This study investigates the long-term functional and oncologic outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL). MATERIALS AND METHODS Twenty-three patients with supraglottic laryngeal cancer who underwent TORS-SGL between 2012 and 2015 at a tertiary referral hospital were retrospectively analyzed with at least 5 years of follow-up. The head and neck tumor council and the multidisciplinary oncological board decided whether the patients were suitable for robotic surgery, and the necessity of adjuvant radiotherapy or chemotherapy. Inclusion criteria was histopathological diagnosis of squamous cell carcinoma of the larynx. RESULTS Twenty-one patients with T1-T3 supraglottic squamous cell carcinoma were included in this study. Mean follow-up was 48.8 months. Local control was 94.4 % at 2 years and 85.9 % at 5 years. Disease-free survival and overall survival were 85.7 % and 81 % at 2 years and 69.3 % and 57.1 % at 5 years, respectively. There was no permanent tracheostomy or prolonged swallowing dysfunction among patients. Age, perineural and lymphovascular invasion were found to be risk factors affecting overall survival. CONCLUSION TORS-SGL is a feasible, safe and reliable approach with excellent functional results for T1, T2, and selected T3 supraglottic tumors, providing acceptable long-term oncologic results when compared to alternative treatment modalities.
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Affiliation(s)
- Togay Müderris
- Izmir Bakırçay University Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Izmir, Turkey.
| | - Ergün Sevil
- Alaaddin Keykubat University Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Antalya, Turkey
| | - Fatih Gül
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ankara, Turkey
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Williamson A, Jashek-Ahmed F, Hardman J, Paleri V. Functional and quality-of-life outcomes following salvage surgery for recurrent squamous cell carcinoma of the head and neck: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4597-4618. [PMID: 37329358 DOI: 10.1007/s00405-023-08056-z] [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: 04/25/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recurrent head and neck squamous cell carcinomas (HNSCC) are frequently managed with salvage surgery, but the impact these operations have on function and quality-of-life (QoL) is understudied. This review aimed to provide a quantitative and qualitative assessment of the functional and QoL effects of salvage surgical procedures. METHODS Systematic review and meta-analysis were conducted of studies reporting QoL and function following salvage HNSCC resections. RESULTS The search identified 415 articles and 34 were selected for inclusion. Pooled random effects analysis revealed long-term feeding and tracheostomy tube rates of 18% and 7%. Pooled long-term feeding tube rates in open oral and oropharyngeal, transoral robotic, total and partial laryngectomy surgeries were 41%, 25%, 11% and 4%. Eight studies used validated QoL questionnaires. CONCLUSIONS Functional and QoL outcomes from salvage surgery are acceptable, but appear to be worse following open procedures. Prospective studies measuring changes over time are needed to assess these procedures impact on patient well-being.
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Affiliation(s)
- Andrew Williamson
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK.
- Institute for Cancer Research, London, UK.
| | - Farizeh Jashek-Ahmed
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - John Hardman
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Institute for Cancer Research, London, UK
| | - Vinidh Paleri
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Institute for Cancer Research, London, UK
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Turner MT, Chung J, Noorkbash S, Topf MC, Hardman J, Holsinger FC, Paleri V. Complications following salvage transoral robotic surgery with and without reconstruction: A systematic review of the literature. Oral Oncol 2023; 145:106467. [PMID: 37454544 DOI: 10.1016/j.oraloncology.2023.106467] [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: 02/12/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Transoral robotic surgery (TORS) has been used in the salvage setting for head and neck cancers both with and without reconstruction. The complications of salvage TORS and the effect of reconstruction on complications has not been studied. OBJECTIVE To study the complications of salvage TORS and examine the effect of reconstruction on complication rates. METHOD An electronic search of the English- language literature using PubMed, Medline, and the Cochrane database was conducted and a systematic review performed in accordance with PRISMA guidelines (CRD42020181057). RESULTS A total of 23 studies including 533 patients have been published on salvage TORS.The average patient age was 61.2 years.Prior treatment was described for 420 patients.205 (48.8%) underwent prior definitive radiotherapy (RT).160 (38.1%) underwent definitive chemoradiotherapy (CRT).Only 55 (13.1%) had prior surgery.Overall, there were 158 complications with a pooled rate of 33.6% (95%CI: 25.4-42.3%).77 were major complications requiring surgical intervention with a pooled rate of 18.9% (95% CI: 14.8-23.3%).The number of patients undergoing reconstruction among salvage cases in the literature is 59 (9.19%), with 24 local flaps and 25 microvascular free flaps.Reconstruction was associated with lower overall hemorrhage rates but had no impact on major hemorrhage rates. CONCLUSIONS The pooled incidence rates of major complications, major POH and emergency tracheostomy following salvage TORS are 18.9%, 10.5%, and 4.4%.The rate of death following salvage TORS is 3.6%. Reconstruction was associated with lower overall hemorrhage rate after salvage TORS but had no impact on major postoperative hemorrhage rates.
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Affiliation(s)
- Meghan T Turner
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA.
| | - Jeffson Chung
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Seth Noorkbash
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA
| | | | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
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De Virgilio A, Pellini R, Cammaroto G, Sgarzani R, De Vito A, Gessaroli M, Costantino A, Petruzzi G, Festa BM, Campo F, Moretti C, Pichi B, Mercante G, Spriano G, Vicini C, Meccariello G. Trans oral robotic surgery for oropharyngeal cancer: A multi institutional experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106945. [PMID: 37331862 DOI: 10.1016/j.ejso.2023.05.020] [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: 01/11/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse oncological outcomes of OPSCC patients treated with TORS. MATERIALS AND METHODS This study involved 139 patients with OPSCC, treated with TORS between 2008 and 2020. Clinicopathological characteristics, treatment details and oncological outcomes were evaluated retrospectively. RESULTS The management strategies included TORS alone in 42.5%, TORS-RT in 25.2% and TORS-CRT in 30.9%. The ENE was noted in 28.8% of neck dissections. In 19 patients clinically classified as unknown primaries, the primary was found in 73.7%. Rates of local, regional relapses and distant metastasis were 8.6%, 7.2%, and 6.5%, respectively. The 5 year- Overall Survival and Disease Free Survival were 69.6% and 71.3%, respectively. CONCLUSION TORS fits well in the modern management of OPSCC. Although definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of the therapeutic strategy requires evaluation by a multidisciplinary team.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Giovanni Cammaroto
- Otolaryngology and Head-Neck Surgery Unit, Department of Surgery, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Rossella Sgarzani
- Plastic Surgery, DIMES Department, University of Bologna, Bologna, Italy
| | - Andrea De Vito
- Otolaryngology and Head-Neck Surgery Unit, Department of Surgery, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Manlio Gessaroli
- Maxillo-Facial Unit, Department of Surgery, Maurizio Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Flaminia Campo
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Moretti
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy; University of Ferrara, Ferrara, Italy
| | - Barbara Pichi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Claudio Vicini
- Otolaryngology and Head-Neck Surgery Unit, Department of Surgery, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy; University of Ferrara, Ferrara, Italy
| | - Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Department of Surgery, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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Hardman JC, Holsinger FC, Brady GC, Beharry A, Bonifer AT, D’Andréa G, Dabas SK, de Almeida JR, Duvvuri U, Floros P, Ghanem TA, Gorphe P, Gross ND, Hamilton D, Kurukulasuriya C, Larsen MHH, Lin DJ, Magnuson JS, Meulemans J, Miles BA, Moore EJ, Pantvaidya G, Roof S, Rubek N, Simon C, Subash A, Topf MC, Van Abel KM, Vander Poorten V, Walgama ES, Greenlay E, Potts L, Balaji A, Starmer HM, Stephen S, Roe J, Harrington K, Paleri V. Transoral Robotic Surgery for Recurrent Tumors of the Upper Aerodigestive Tract (RECUT): An International Cohort Study. J Natl Cancer Inst 2022; 114:1400-1409. [PMID: 35944904 PMCID: PMC9552281 DOI: 10.1093/jnci/djac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/04/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness. METHODS A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC. RESULTS Data for 278 eligible patients were analyzed, with median follow-up of 38.5 months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0 mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0 mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0 mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n = 22 of 272), and 30-day mortality was 1.8% (n = 5 of 272). At 1 year, 10.8% (n = 21 of 195) used tracheostomies, 33.8% (n = 66 of 195) used gastrostomies, and 66.3% (n = 53 of 80) had maintained or improved normalcy of diet scores. CONCLUSIONS Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting.
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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - F Chris Holsinger
- Department of Otolaryngology—H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Grainne C Brady
- Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK
| | - Avinash Beharry
- Department of Otolaryngology—H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Alec T Bonifer
- Department of Otolaryngology—H&N Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Gregoire D’Andréa
- Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France
| | - Surender K Dabas
- Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India
| | - John R de Almeida
- Department of Otolaryngology—H&N Surgery, University Health Network, Toronto, ON, Canada
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Floros
- Department of Otolaryngology—H&N Surgery, Florida Hospital Group, Celebration, FL, USA
| | - Tamer A Ghanem
- Department of Otolaryngology—H&N Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Philippe Gorphe
- Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France
| | - Neil D Gross
- Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - David Hamilton
- Department of Otolaryngology—H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK
| | - Chareeni Kurukulasuriya
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Daniel J Lin
- Department of Otolaryngology—H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK
| | - J Scott Magnuson
- Department of Otolaryngology—H&N Surgery, Florida Hospital Group, Celebration, FL, USA
| | - Jeroen Meulemans
- Otorhinolaryngology—Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Northwell Health System, New York, NY, USA
| | - Eric J Moore
- Department of Otolaryngology—H&N Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gouri Pantvaidya
- Department of H&N Surgery, Tata Memorial Hospital, Mumbai, India
| | - Scott Roof
- Department of Otolaryngology, Mount Sinai Hospital, New York City, NY, USA
| | - Niclas Rubek
- Department of Head and Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Simon
- Department of Otolaryngology—H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Anand Subash
- Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India
| | - Michael C Topf
- Department of Otolaryngology—H&N Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology—H&N Surgery, Mayo Clinic, Rochester, MN, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology—Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Evan S Walgama
- Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Greenlay
- Clinical Trials Unit, The Royal Marsden Hospital, London, UK
| | - Laura Potts
- Clinical Trials Unit, The Royal Marsden Hospital, London, UK
| | - Arun Balaji
- Department of H&N Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Heather M Starmer
- Department of Otolaryngology—H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Sarah Stephen
- Department of Otolaryngology—H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK
| | - Justin Roe
- Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK
| | | | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
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7
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Transoral robotic surgery for oropharyngeal cancer in the era of chemoradiation therapy. Auris Nasus Larynx 2022; 49:535-546. [DOI: 10.1016/j.anl.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/26/2021] [Accepted: 01/18/2022] [Indexed: 12/26/2022]
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8
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A prospective longitudinal study of quality of life in robotic-assisted salvage surgery for oropharyngeal cancer. Eur J Surg Oncol 2022; 48:1243-1250. [DOI: 10.1016/j.ejso.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 11/12/2022] Open
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Vander Poorten V, Meulemans J, Beitler JJ, Piazza C, Kowalski LP, Mäkitie AA, Paleri V, Rinaldo A, Robbins KT, Rodrigo JP, Silver CE, Sjögren EV, Strojan P, Takes RP, Ferlito A. Salvage surgery for residual or recurrent laryngeal squamous cell carcinoma after (Chemo)radiotherapy: Oncological outcomes and prognostic factors. Eur J Surg Oncol 2021; 47:2711-2721. [PMID: 34059377 DOI: 10.1016/j.ejso.2021.05.035] [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: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
Nonsurgical primary treatment of early and advanced laryngeal squamous cell carcinoma, employing radiotherapy with or without chemotherapy, is considered a standard of care in many centers throughout the world. When patients have persistent or recurrent disease after non-surgical treatment, salvage surgery is frequently the only remaining potentially curative treatment. Depending on the extent of the residual/recurrent disease, different surgical salvage options are at the surgeon's disposal. In selected cases with limited local disease, salvage transoral laser microsurgery, transoral robotic surgery and open partial laryngectomies can be employed to achieve cure while preserving laryngeal function. For more advanced cases total laryngectomy is necessary. Identifying situations with unacceptable results from surgical salvage may guide future therapies.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki, University Hospital, FI-00029, HUS Helsinki, Finland
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, The Institute of Cancer Research, Brompton Road, London, UK
| | | | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Elisabeth V Sjögren
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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10
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Functional and oncological outcomes of salvage transoral robotic surgery: a comparative study. Eur Arch Otorhinolaryngol 2021; 279:457-466. [PMID: 33880636 DOI: 10.1007/s00405-021-06812-7] [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: 02/26/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Transoral robotic surgery (TORS) as a first-line therapy has been well-documented but evidence is missing regarding salvage therapy. The aim of this study is to compare the oncological and functional outcomes of TORS as a primary and salvage therapy. METHODS This retrospective monocentric study included 74 patients operated by a single surgeon and sorted out into two groups: primary treatment (PT) or Salvage treatment (ST) in case of previous history of radiation therapy. Patients were further stratified by tumour location: larynx and pharynx (lST vs lPT and pST vs pPT). RESULTS Forty-eight patients were included in PT group (64.9%) and 26 in ST group (35.1%). ST patients had more frequent cTis/T1 tumours (57.7% vs 29.2%, p = 0.0164) and no clinical lymph disease (3.8% vs 37.5%, p = 0.0016). Tracheostomy was more often performed in the ST group (57.7% vs 16.7%, p = 0.0003) and the lST subgroup (88.9% vs 9.1%, p < 0.0001). Gastric feeding tube placement was more frequent in the ST group (76.9% vs 33.3%, p = 0.0003), the pST subgroup (64.7% vs 15.4%, p = 0.0009) and the lST subgroup (100% vs 54.5%, p = 0.0297). We observed a trend for more postoperative complications in the ST group (69.2% vs 47.9%, p = 0.0783). The overall survival was lower in the ST group (p = 0.0004), and in the pST subgroup (p < 0.0001). The disease-free survival rate was lower in the ST group (p = 0.0001), the pST subgroup (p = 0.0002) and the lST subgroup (p = 0.0328). CONCLUSION This study confirms that survival and functional outcomes after salvage TORS are worse than in first line surgery.
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Quek LHH, Lim MY, Cheo T, Teo HL, Pua U. Percutaneous Management of Recurrent Head and Neck Cancer: Current Role and Evolving Principles in the Multidisciplinary Setting. Curr Oncol Rep 2021; 23:52. [PMID: 33754244 DOI: 10.1007/s11912-021-01045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW In this review, we will outline the role of percutaneous interventional radiological management of recurrent head and neck (H&N) cancer in the context of a multidisciplinary setting which consists of surgery, radiation therapy, as well as established and evolving systemic therapies that may impact current practice. RECENT FINDINGS Management of recurrent H&N cancer is complex, with attention to the preservation of function and minimal treatment-related morbidity. The favored treatment modalities in local recurrence previously treated with radiotherapy are surgical resection, and if unresectable, for chemotherapy as definitive treatment, or as a prelude to resection if there is good tumor response. Unfortunately, some of these patients are too frail for major surgery or to withstand the toxicity of chemotherapy. There is a gap for effective local therapy without the morbidity of surgery, toxicity of re-irradiation, and systemic side effects of chemotherapy. Percutaneous interventions have the potential to bridge that gap as well as provide palliative symptomatic treatment for patients that have exhausted all treatment options. In the multidisciplinary setting involving the treatment of complex recurrent H&N cancer, percutaneous management now plays a viable and effective role with a foothold in this team-based approach.
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Affiliation(s)
- Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Ming Yann Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Otorhinolaryngology and Head and Neck Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Radiation Oncology, National University Health System, Singapore, Singapore
| | - Hui Lin Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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León X, García J, López M, Bulboa C, Pujals G, Quer M. Oncological Results of Salvage Treatment in Patients With Hypopharyngeal Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Transoral robotic surgery in Ireland: the beginning. Ir J Med Sci 2021; 191:361-365. [PMID: 33559869 DOI: 10.1007/s11845-021-02539-w] [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: 12/05/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Transoral robotic surgery (TORS) has shown promising results in the treatment of myriad head and neck pathologies but is now most commonly used in the investigation and management of oropharyngeal squamous cell carcinoma. AIMS The aim of this study was to report our cases of the newly introduced TORS, particularly its role in identifying primary of unknown origin and the potential implications for patients. A literature review and our early experience should begin to debunk some of the criticisms of TORS including setup times and cost. METHODS Prospective data was collected from all patients undergoing transoral robotic surgery including demographics, indication, histology results in primary of unknown origin and complications. RESULTS We have performed 36 TORS procedures in total ranging from intermediate to major complex. Our complication rate is low, and this has improved with the passage of time. Haemorrhage rates remain at 5.6% (n = 2), and the average length of stay is 1 day. Successful identification of a primary tumour in cancer of unknown primary was 80% (n = 8). CONCLUSIONS We anticipate the integration of TORS into routine practice in the investigation and management of a number of ENT pathologies following robust clinical trials.
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Asairinachan A, O'Duffy F, Fua T, Magarey MJR, Dixon BJ. Salvage transoral robotic surgery in early-stage oropharyngeal recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:18-25. [PMID: 33744203 DOI: 10.1016/j.oooo.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Limited data are currently available regarding outcomes following transoral robotic surgery (TORS) in the salvage setting. This study aims to investigate the functional and oncological outcomes following TORS in salvage oropharyngeal tumors. STUDY DESIGN All patients undergoing salvage TORS for a residual, recurrent, or new primary oropharyngeal squamous cell carcinoma within a previously radiated field between March 2014 and October 2018 were included. Patients undergoing salvage TORS for other subsites were excluded. Margin status, complication rates, long-term tracheostomy, and gastrostomy requirements and overall and disease-free survival outcomes were recorded. RESULTS A total of 26 patients were included. Three patients (11%) experienced a TORS-specific major complication. A gastrostomy tube was required in 42% of patients on discharge (n = 11), and in 28% of patients on long-term follow-up (n = 7) at a median of 34 (interquartile range, 11.8-47.8) months. A tracheostomy was placed in 5 patients and all were removed before discharge. The 3-year overall survival and disease-free survival were 74% and 70%, respectively. CONCLUSION Salvage TORS is a viable and effective option in the management of selected tumors within a previously radiated field.
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Affiliation(s)
- Ashwinna Asairinachan
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Fergal O'Duffy
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre
| | - Matthew J R Magarey
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Head & Neck Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Benjamin J Dixon
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Head & Neck Surgery, Epworth Healthcare, Richmond, Victoria, Australia
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15
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Parhar HS, Yver CM, Brody RM. Current Indications for Transoral Robotic Surgery in Oropharyngeal Cancer. Otolaryngol Clin North Am 2020; 53:949-964. [PMID: 32912662 DOI: 10.1016/j.otc.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing dramatically and is conclusively linked to increasing rates of human papillomavirus (HPV) infection. HPV-related oropharyngeal cancers have been shown to occur in a unique demographic group and show favorable oncologic outcomes compared with HPV-negative OPSCC. There has been a paradigm shift in the treatment of early-stage OPSCC, with most patients now undergoing primary surgery in the United States. Transoral robotic surgery is associated with excellent oncologic and functional outcomes in the treatment of OPSCC and is increasingly being used for a broader range of oropharyngeal indications.
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Affiliation(s)
- Harman S Parhar
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA
| | - Christina M Yver
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA.
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16
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Lechien JR, Fakhry N, Saussez S, Chiesa-Estomba CM, Chekkoury-Idrissi Y, Cammaroto G, Melkane AE, Barillari MR, Crevier-Buchman L, Ayad T, Remacle M, Hans S. Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review. Oral Oncol 2020; 109:104848. [PMID: 32534362 DOI: 10.1016/j.oraloncology.2020.104848] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this systematic review is to shed light the current indications and outcomes of transoral robotic surgery (TORS) supraglottic laryngectomy (SGL) in patients with supraglottic laryngeal cancer. METHODS PubMed, Scopus and Cochrane Library were searched by three independent otolaryngologists from the Young Otolaryngologists of IFOS for studies investigating the indications, effectiveness and safety of TORS SGL. Surgical, functional, and survival outcomes have been investigated. Inclusion/exclusion criteria; demographic data; and clinical outcome evaluation of papers were analyzed using PRISMA criteria. RESULTS A total of 14 papers met our inclusion criteria, accounting for 422 patients (335 males & 87 females). The tumor location mainly consisted of epiglottis (55.4%), aryepglottic fold (31.2%), and ventricular band (5.1%). The following tumor stages were considered: cT1 (35.8%); cT2 (48.6%) and cT3 (13.9%). Feeding tube and percutaneous endoscopic gastrostomy were used in 62.5% and 8.82% of patients, respectively. The 24-month local & regional control rates ranged from 94.3% to 100% and 87.5% to 94.0%, respectively. The 2-year and 5-year overall survival rates ranged from 66.7% to 88.0% and 78.7% to 80.2%, respectively. There was an important heterogeneity between studies with regard to the inclusion/exclusion criteria, follow-up times, complications analysis; surgical and functional outcomes. CONCLUSION TORS SGL is an effective approach for treating patients with early stages supraglottic cancers. Future controlled studies are needed to compare functional and survival outcomes between TORS SGL and other surgical approaches. Recommendations have been provided for future studies for better inclusion of patients, analysis of complications and functional outcomes.
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Affiliation(s)
- Jerome R Lechien
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
| | - Nicolas Fakhry
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otorhinolaryngology-Head & Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos-Miguel Chiesa-Estomba
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Younes Chekkoury-Idrissi
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Giovanni Cammaroto
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Antoine E Melkane
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Maria Rosaria Barillari
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Lise Crevier-Buchman
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Tareck Ayad
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Marc Remacle
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otorhinolaryngology and Head and Neck Surgery, CH Luxembourg, Luxembourg
| | - Stéphane Hans
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
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León X, García J, López M, Bulboa C, Pujals G, Quer M. Oncological results of salvage treatment in patients with hypopharyngeal carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:85-91. [PMID: 32473712 DOI: 10.1016/j.otorri.2020.02.005] [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: 12/02/2019] [Revised: 01/18/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE The aim of this study is to analyse the variables related to the feasibility of salvage surgery with radical intention in patients with a local recurrence of hypopharyngeal carcinoma, and to evaluate the oncological performance of this type of surgery. METHODS Retrospective study of 96 patients with hypopharyngeal carcinoma with local tumour recurrence RESULT: Only 27 patients (28.1%) were considered for surgical salvage treatment. The variables related to feasibility of salvage surgery were non-surgical initial treatment of the tumour and a disease-free interval greater than 6 months. All 69 patients non-candidates for salvage surgery died as a result of tumour progression in a period of less than 2.5 years. The 5-year disease-specific survival rate for the patients treated with salvage surgery was 39.5%. The only variable significantly related to disease-specific survival was the status of the resection margins. Patients with extensive tumour recurrence (rT3-T4) or with simultaneous nodal involvement had a lower survival rate, but the differences did not reach statistical significance. CONCLUSION Only 28% of the patients with hypopharyngeal carcinoma with local recurrence of the tumour were eligible for salvage surgery with radical intention. The patients treated with salvage surgery had a 5 -year disease-specific survival of 39.5%.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Constanza Bulboa
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Gerard Pujals
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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18
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Hardman J, Liu Z, Brady G, Roe J, Kerawala C, Riva F, Clarke P, Kim D, Bhide S, Nutting C, Harrington K, Paleri V. Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis. Head Neck 2020; 42:1089-1104. [DOI: 10.1002/hed.26100] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 01/28/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- John Hardman
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - ZiWei Liu
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Grainne Brady
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
| | - Justin Roe
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
- Department of Surgery and Cancer Imperial College London UK
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust London UK
| | - Cyrus Kerawala
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Francesco Riva
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Peter Clarke
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust London UK
| | - Dae Kim
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Shreerang Bhide
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Christopher Nutting
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Kevin Harrington
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Vinidh Paleri
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
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Management of the irradiated N0-neck during salvage pharyngo-laryngeal surgery. Eur J Surg Oncol 2020; 46:1059-1065. [PMID: 31952930 DOI: 10.1016/j.ejso.2020.01.011] [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] [Received: 12/02/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Salvage surgeries are challenging procedures, with an associated poor prognosis. Management of the N0 neck in those situations remains controversial. We aim to compare oncologic outcomes regarding neck management after surgery for N0 pharyngo-laryngeal carcinoma occurring after loco-regional radiotherapy. METHODS We conducted a multicentric retrospective study, including all patients undergoing surgery for persistent, recurrent or new primary N0 carcinoma of the oropharynx, hypopharynx or larynx between 2005 and 2015, following loco-regional radiotherapy. RESULTS A total of 239 patients were included, concerning respectively 44%, 34% and 22% oropharyngeal, laryngeal and hypopharyngeal tumors operated. A neck dissection was performed in 143 patients (60%), with an occult nodal metastasis rate of 9%. This rate was higher for hypopharyngeal carcinomas (18%, p = 0.16) and tumors with initial nodal involvement (16%, p = 0.05). With a median follow-up of 60 months, the median overall survival (OS) and progression-free survival rates (PFS) were 34 months and 25 months. We identified negative margin excision status, age at the time of surgery (under 60) and delay between RT and surgery over 2 years as the only variables associated with better OS (p < 0.0001 and p = 0.004) and PFS (p < 0.0001 and p = 0.010) in multivariable analysis, with no difference regarding neck management. Regional progression (alone or with distant metastasis) was noted in 10 cases: 4 in the neck observation group (4%) versus 6 in the neck dissection group (4%). CONCLUSION Elective lymph node dissection of irradiated neck should not be routinely performed in patients undergoing surgery for persistent, recurrent or new primary pharyngo-laryngeal carcinomas.
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Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes. The Journal of Laryngology & Otology 2019; 133:884-888. [PMID: 31475640 DOI: 10.1017/s002221511900183x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed. METHODS A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes. RESULTS There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing of the flap onto the resection bed was successful in all cases. CONCLUSION The facial artery musculomucosal flap provides a suitable transoral local flap option for selected patients undergoing salvage transoral robotic surgery for oropharyngeal malignancies.
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Golusiński W, Golusińska-Kardach E. Current Role of Surgery in the Management of Oropharyngeal Cancer. Front Oncol 2019; 9:388. [PMID: 31179239 PMCID: PMC6542993 DOI: 10.3389/fonc.2019.00388] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
In the last few decades, the surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) has undergone enormous changes. Until the 1990s, open surgery was the primary treatment for OPSCC. However, due to the potentially severe functional morbidity of this approach, open surgery was largely displaced by concurrent chemoradiotherapy (CRT) in the 1990s. At the same time, new, less-invasive surgical approaches such as transoral surgery with monopolar cautery began to emerge, with the potential to reduce functional morbidity and avoid the late-onset toxicity of CRT. More recently, the growing incidence of HPV-positive disease has altered the patient profile of OPSCC, as these patients tend to be younger and have a better long-term prognosis. Consequently, this has further bolstered interest in minimally-invasive techniques to de-intensify treatment to reduce long-term toxicity and treatment-related morbidity. In this context, there has been a renewed interest in the primary surgery, which allows for accurate pathologic staging and thus—potentially—de-intensification of postoperative CRT. The continuous advances in minimally-invasive surgical approaches, including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), have also altered the surgical landscape. These minimally-invasive approaches offer excellent functional outcomes, without the severe toxicity associated with intensive CRT, thus substantially reducing treatment-related morbidity. In short, given the increasing prevalence of HPV-positive OPSCC, together with the severe long-term sequela of aggressive CRT, surgery appears to be recapturing its previous role as the primary treatment modality for this disease. While a growing body of evidence suggests that TLM and TORS offer oncologic outcomes that are comparable to CRT and open surgery, many questions remain due to the lack of prospective data. In the present review, we explore the emerging range of surgical options and discuss future directions in the treatment of OPSCC, including the most relevant clinical trials currently underway.
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Affiliation(s)
- Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Golusiński W. Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond. Front Oncol 2019; 9:293. [PMID: 31058091 PMCID: PMC6479210 DOI: 10.3389/fonc.2019.00293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
In recent years, interest in functional organ preservation surgery (FOPS) in the treatment of head and neck cancer has increased dramatically as clinicians seek to minimize the adverse effects of treatment while maximizing survival and quality of life. In this context, the use of transoral robotic surgery (TORS) is becoming increasingly common. TORS is a relatively new and rapidly-evolving technique, with a growing range of treatment indications. A wide range of novel, flexible surgical robots are now in development and their commercialization is expected to significantly expand the current indications for TORS. In the present review, we discuss the current and future role of this organ-preserving modality as the central element in the multimodal treatment of head and neck cancer.
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Affiliation(s)
- Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Vander Poorten V, Triantafyllou A, Skálová A, Stenman G, Bishop JA, Hauben E, Hunt JL, Hellquist H, Feys S, De Bree R, Mäkitie AA, Quer M, Strojan P, Guntinas-Lichius O, Rinaldo A, Ferlito A. Polymorphous adenocarcinoma of the salivary glands: reappraisal and update. Eur Arch Otorhinolaryngol 2018; 275:1681-1695. [PMID: 29761209 DOI: 10.1007/s00405-018-4985-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 12/29/2022]
Abstract
Although relatively rare, polymorphous adenocarcinoma (PAC) is likely the second most common malignancy of the minor salivary glands (MiSG). The diagnosis is mainly based on an incisional biopsy. The optimal treatment comprises wide surgical excision, often with adjuvant radiotherapy. In general, PAC has a good prognosis. Previously, PAC was referred to as polymorphous low-grade adenocarcinoma (PLGA), but the new WHO classification of salivary gland tumours has also included under the PAC subheading, the so-called cribriform adenocarcinoma of minor salivary glands (CAMSG). This approach raised controversy, predominantly because of possible differences in clinical behaviour. For example, PLGA (PAC, classical variant) only rarely metastasizes, whereas CAMSG often shows metastases to the neck lymph nodes. Given the controversy, this review reappraises the definition, epidemiology, clinical presentation, diagnostic work-up, genetics, treatment modalities, and prognosis of PAC of the salivary glands with a particular focus on contrasting differences with CAMSG.
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Affiliation(s)
- Vincent Vander Poorten
- Department of Oncology-Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium. .,Multidisciplinary Salivary Gland Society, Geneva, Switzerland.
| | - Asterios Triantafyllou
- School of Dentistry, University of Liverpool, Liverpool, UK.,Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK
| | - Alena Skálová
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Göran Stenman
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Pathology and Genetics, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Esther Hauben
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Henrik Hellquist
- Epigenetics and Human Disease Laboratory, CBMR, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Simon Feys
- Department of Oncology-Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Miquel Quer
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Orlando Guntinas-Lichius
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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24
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Abstract
How trans-oral robotic surgery can treat cancer in the oropharyngyal space
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Affiliation(s)
- F Borumandi
- Western Sussex Hospitals NHS Foundation Trust
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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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Gorphe P. A Contemporary Review of Evidence for Transoral Robotic Surgery in Laryngeal Cancer. Front Oncol 2018; 8:121. [PMID: 29721446 PMCID: PMC5915483 DOI: 10.3389/fonc.2018.00121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/04/2018] [Indexed: 12/03/2022] Open
Abstract
Numerous studies have shown that transoral robotic surgery (TORS) for oropharyngeal cancers is safe and that it yields satisfactory functional and oncological outcomes. For many teams worldwide, it is therefore a standard surgical approach with eligible patients. In the same time, TORS is increasingly being used and described in the context of laryngeal cancer surgery. It is proposed as an alternative to open approaches, which may yield inconsistent functional results and significant rates of postoperative complications. It may also be an alternative to definitive radiotherapy, which entails significant early and late toxicities. Moreover, it has been explored as an alternative to endoscopic laser surgery in patients with difficult exposure, even though there is still a lack of evidence about which procedure provides better vizualization of the vocal cords. This article provides a review of the indications for TORS in laryngeal cancer, the peri-operative morbidity, functional outcomes, and oncological results.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, France
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27
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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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