858 Transoral Robotic Surgery: Comparing the Geography of Research Publications with The Global Burden of Disease

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C S Jones ◽  
G Higginbotham ◽  
A Gormley ◽  
K Jones ◽  
B G Main
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Disease Burden ◽  
Transoral Robotic Surgery ◽  
Equitable Access ◽  
Middle Income ◽  
Healthcare Settings ◽  
The Usa ◽  
Research Findings ◽  
Global Disease Burden

Abstract Introduction Transoral robotic surgery (TORS) is increasingly used for the resection of oropharyngeal tumours. It is unclear if there is equitable access to this innovative technique worldwide, specifically in areas of greatest need. This study aimed to map the geographic distribution of publications on TORS and compare this to global disease burden. Method Systematic searches identified all studies of TORS from inception to 2018. The country of origin of each study was identified. The incidence and age standardised rate (ASR) of oropharyngeal cancer for each country was obtained from The Global Cancer Observatory (GLOBOCAN) database. World Bank classifications of countries by income level were obtained. Results A total of 132 studies were identified. The majority (96%) were published in high-income countries, 2% in lower-middle, and 2% in upper-middle income countries. Eighty-nine were published in the USA, the country with the second-highest incidence of oropharyngeal cancer worldwide (13% of total), but 20th by ASR. The greatest incidence was in India (21%), however this was the source of only 2% of studies. Of the ten countries with the highest incidence, eight were represented in published studies, in comparison to four of the top 10 by ASR. Conclusions There is evident disparity in the geographical distribution of published studies of TORS. This disparity may represent unequal access to surgical technologies, or a lack of evaluation of the technology in different healthcare settings. This may impact the generalisability of research findings. Equitable access to novel surgical technologies is ethical and can help address global disease burden.

scholarly journals 1096 Robot-Assisted Minimally Invasive Oesophagectomy: Comparing the Geography of Research Publication with The Global Burden of Disease

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Higginbotham ◽  
B Zucker ◽  
J Ramirez ◽  
E N Kirkham ◽  
C S Jones ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Oesophageal Cancer ◽  
Disease Burden ◽  
Equitable Access ◽  
Robot Assisted ◽  
Middle Income ◽  
Healthcare Settings ◽  
The Usa ◽  
Minimally Invasive Oesophagectomy ◽  
Global Disease Burden

Abstract Introduction Robot-assisted minimally invasive oesophagectomy (RAMIE) is increasingly used in the management of oesophageal tumours. It is unclear if there is equitable access to this innovative technique worldwide, specifically in areas of greatest need. This study aimed to map the geographic distribution of publications on RAMIE and compare this to global disease burden. Method Systematic searches identified all studies of RAMIE from inception to 2020. The country of origin of each study was identified. The incidence and age standardised rate (ASR) of oesophageal cancer for each country was obtained from The Global Cancer Observatory (GLOBOCAN) database. World Bank classifications of countries by income level were obtained. Results A total of 103 studies were identified. The majority (81%) were published in high-income countries, 15% in upper-middle, and 5% in lower-middle income countries. Thirty-four were published in the USA, the country with the fifth-highest incidence of oesophageal cancer worldwide, but 90th by ASR. The greatest incidence was in China (54% of global incidence) but was the source of only 15% of studies. Of the ten countries with the highest incidence, five were represented in published studies, in comparison to one of the top 10 by ASR. Conclusions There is evident disparity in the geographical distribution of published studies of RAMIE. This disparity may represent unequal access to surgical technologies, or a lack of evaluation of the technology in different healthcare settings. This may impact the generalisability of research findings. Equitable access to novel surgical technologies is ethical and can help address global disease burden.

Preferences and utilities for health states after treatment for oropharyngeal cancer: Transoral robotic surgery versus definitive (chemo)radiotherapy

Head & Neck ◽  
2014 ◽  
Vol 36 (7) ◽  
pp. 923-933 ◽  
Author(s):  
John R. de Almeida ◽  
Nathaniel L. Villanueva ◽  
Alan J. Moskowitz ◽  
Brett A. Miles ◽  
Marita S. Teng ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery ◽  
Health States

scholarly journals Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

2016 ◽  
Vol 142 (7) ◽  
pp. 691 ◽  
Author(s):  
Arun Sharma ◽  
Sapna Patel ◽  
Fred M. Baik ◽  
Grant Mathison ◽  
Brendan H. G. Pierce ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Modern Treatment Outcomes for Early T-Stage Oropharyngeal Cancer Treated With Intensity-modulated Radiation Therapy at a Tertiary Care Institution

2020 ◽  
Author(s):  
Eric J. Di Gravio ◽  
Pencilla Lang ◽  
Hugh Andrew Jinwook Kim ◽  
Tricia Chinnery ◽  
Neil Mundi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Early Stage ◽  
Tertiary Care ◽  
Feeding Tube ◽  
The United States ◽  
Transoral Robotic Surgery ◽  
Transoral Surgery ◽  
Severe Toxicity ◽  
T Stage

Abstract BackgroundTransoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT.MethodsConsecutive cases of early T stage (T1-T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014-2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the CTCAE criteria.ResultsA total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p=0.0026). ConclusionsPrimary RT or CRT provides outstanding survival for early T-stage HPV-positive disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

Evaluating dysphagia and xerostomia outcomes following transoral robotic surgery for patients with oropharyngeal cancer

Head & Neck ◽  
2021 ◽  
Author(s):  
Mitesh P. Mehta ◽  
Rebecca Prince ◽  
Zeeshan Butt ◽  
Bryce E. Maxwell ◽  
Brittni N. Carnes ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Dysphagia After Primary Transoral Robotic Surgery With Neck Dissection vs Nonsurgical Therapy in Patients With Low- to Intermediate-Risk Oropharyngeal Cancer

2019 ◽  
Vol 145 (11) ◽  
pp. 1053 ◽  
Author(s):  
Katherine A. Hutcheson ◽  
Carla L. Warneke ◽  
Christopher M. K. L. Yao ◽  
Jhankruti Zaveri ◽  
Baher E. Elgohari ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Neck Dissection ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery ◽  
Intermediate Risk ◽  
Nonsurgical Therapy

scholarly journals Development of an online, patient-centred decision aid for patients with oropharyngeal cancer in the transoral robotic surgery era

2017 ◽  
Vol 24 (5) ◽  
pp. 318 ◽  
Author(s):  
J.S. Lam ◽  
G.M. Scott ◽  
D.A. Palma ◽  
K. Fung ◽  
A.V. Louie
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Decision Aid ◽  
Transoral Robotic Surgery ◽  
Oncologic Outcomes ◽  
Patient Treatment ◽  
Promising Alternative ◽  
Trade Off ◽  
Cure Rates ◽  
Adult Volunteers

Background  Radiotherapy (rt) has been the standard treatment for early oropharyngeal cancer, achieving excellent outcomes, but with significant toxicities. Transoral robotic surgery (tors) has emerged as a promising alternative. A decision aid (da) can help to establish patient treatment preferences.Methods A da was developed and piloted in 40 healthy adult volunteers. Assuming equal oncologic outcomes of the treatments, participants indicated their preference. The treatment trade-off point was then established, and participant perceptions were elicited.Results More than 80% of participants initially selected tors for treatment, regardless of facilitator background. For all participants, the treatment trade-off point changed after an average 15% cure benefit. Treatment toxicities, duration, novelty, and perceptions all influenced treatment selection. All subjects valued the da.Conclusions A da developed for early oropharyngeal cancer treatment holds promise in the era of shared decision making. Assuming equal cure rates, tors was preferred over rt by healthy volunteers.

scholarly journals Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer

2014 ◽  
Vol 272 (7) ◽  
pp. 1551-1552 ◽  
Author(s):  
Gregory S. Weinstein ◽  
Bert W. O’Malley ◽  
Alessandra Rinaldo ◽  
Carl E. Silver ◽  
Jochen A. Werner ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eric J. Di Gravio ◽  
Pencilla Lang ◽  
Hugh Andrew Jinwook Kim ◽  
Tricia Chinnery ◽  
Neil Mundi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Early Stage ◽  
Tertiary Care ◽  
Feeding Tube ◽  
The United States ◽  
Transoral Robotic Surgery ◽  
Transoral Surgery ◽  
Severe Toxicity ◽  
T Stage

Abstract Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

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