scholarly journals Transoral Robotic Surgery for Pharyngeal and Laryngeal Cancers—A Prospective Medium-Term Study

2021 ◽  
Vol 10 (5) ◽  
pp. 967
Author(s):  
Chen-Chi Wang ◽  
Wen-Jiun Lin ◽  
Yi-Chun Liu ◽  
Chien-Chih Chen ◽  
Shang-Heng Wu ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Functional Outcomes ◽  
Early Stage ◽  
Medical Center ◽  
Tumor Resection ◽  
Tube Feeding ◽  
Potential Method ◽  
Transoral Robotic Surgery ◽  
Kaplan Meier ◽  
Adjuvant Irradiation

Transoral robotic surgery (TORS) has been used for treating pharyngeal and laryngeal cancers for many years. However, the application of neoadjuvant chemotherapy (NACT) before TORS, the sparing rate of adjuvant irradiation after TORS, and the long-term oncologic/functional outcomes of TORS are seldom reported. From September 2014 to May 2018, 30 patients with clinical T1 to T3 cancers of oropharynx (7), larynx (3), and hypopharynx (20) were prospectively recruited for TORS in a tertiary referral medical center. Twelve (40%) patients had clinical early stage (I or II) disease, and 18 (60%) patients had late-stage (III or IV) disease. All 30 patients were suggested to receive TORS with neck dissection. Cisplatin-based NACT was given to 11 patients before the surgery, and it led to a 100% reduction in tumor size. Only 40% of patients needed adjuvant irradiation with a mean dosage of 5933 cGY after TORS. After a mean follow up of 38.9± 14.7 months, the Kaplan–Meier method estimated 5-year disease-specific survival, and organ preservation was 86.3% and 96.2%, respectively. Twenty-five patients were alive without tracheostomy and tube feeding. We found that NACT is a potential method for facilitating tumor resection and TORS effectively de-escalated adjuvant irradiation with a satisfactory 5-year survival and functional outcomes.

scholarly journals Transoral Robotic Surgery for Cancer of the Soft Palate Posterior Surface

2020 ◽  
pp. 014556132097746
Author(s):  
Emilien Chebib ◽  
Jérôme R. Lechien ◽  
Younes Chekkoury ◽  
Stéphane Hans
Keyword(s):  
Squamous Cell Carcinoma ◽  
Surgical Treatment ◽  
Robotic Surgery ◽  
Soft Palate ◽  
Functional Outcomes ◽  
Early Stage ◽  
Tumor Resection ◽  
Transoral Robotic Surgery ◽  
Posterior Surface ◽  
Papilloma Virus

The surgical treatment of oropharyngeal squamous cell carcinoma (OSCC) has undergone a considerable evolution, with, among others, transoral robotic surgery (TORS). However, TORS is rarely used for the surgery of soft palate. A 73-year-old man presented a human papilloma virus OSCC of the posterior soft palate. The tumor was resected using TORS. This report describes the surgical technique step by step of the tumor resection. The resection of early stage OSCC of the posterior surface of soft palate is possible through TORS. The procedure is noninvasive, rapid, and seems to be associated with excellent functional outcomes.

Outcomes of HPV-Negative Oropharyngeal Cancer Treated With Transoral Robotic Surgery

2021 ◽  
pp. 019459982199664
Author(s):  
Ryan S. Jackson ◽  
Katelyn Stepan ◽  
Craig Bollig ◽  
Rahul K. Sharma ◽  
Mihir Patel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Robotic Surgery ◽  
Early Stage ◽  
Treatment Algorithm ◽  
Transoral Robotic Surgery ◽  
Level Of Evidence ◽  
Early Stage Disease ◽  
Kaplan Meier ◽  
User File ◽  
Stage Disease

Objective The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing secondary to human papillomavirus (HPV)–related disease. Despite this, outcomes of patients with HPV-negative OPSCC undergoing transoral robotic surgery (TORS) are largely unknown. Study Design Analysis of the National Cancer Database (NCDB). Setting Not applicable. Methods The 2015 participant user file from the NCDB was analyzed between 2010 and 2015 for patients with OPSCC who underwent TORS and neck dissection. Kaplan-Meier survival analysis was used to estimate overall survival of the study population. Univariable Cox survival analyses was used to determine significant associations between demographic, tumor, and treatment characteristics and overall survival (OS). Results There were 164 patients (124 male and 40 female) with a mean age of 58 years (30-89 years). Median follow-up was 34 months. Five-year OS was 78% (95% CI, 70%-86%). Patients with early stage disease (pT1-2, N0-1) had significantly improved OS compared to patients with advanced T- or N-stage disease (log-rank 0.011; 5-year OS: 88% [95% CI, 78%-98%] vs 66% [95% CI, 50%-82%]). Conclusion Very few patients in the NCDB underwent TORS for HPV-negative OPSCC, but those who did had favorable outcomes, especially in early stage disease. Based on these findings, TORS may be considered in the treatment algorithm for patients with HPV-negative OPSCC. Level of Evidence Level IV.

scholarly journals Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review

Oral Oncology ◽  
2020 ◽  
Vol 109 ◽  
pp. 104848 ◽  
Author(s):  
Jerome R. Lechien ◽  
Nicolas Fakhry ◽  
Sven Saussez ◽  
Carlos-Miguel Chiesa-Estomba ◽  
Younes Chekkoury-Idrissi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Robotic Surgery ◽  
Functional Outcomes ◽  
Transoral Robotic Surgery

Nasogastric tube feeding after transoral robotic surgery for oropharynx carcinoma

2021 ◽  
Vol 42 (3) ◽  
pp. 102857
Author(s):  
Karolina A. Plonowska ◽  
Edgar Ochoa ◽  
Aaron L. Zebolsky ◽  
Neil Patel ◽  
Kathryn R. Hoppe ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Nasogastric Tube ◽  
Tube Feeding ◽  
Transoral Robotic Surgery ◽  
Oropharynx Carcinoma ◽  
Nasogastric Tube Feeding

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.

scholarly journals Transoral Surgery Alone for Human-Papillomavirus–Associated Oropharyngeal Squamous Cell Carcinoma

2013 ◽  
Vol 92 (2) ◽  
pp. 76-83 ◽  
Author(s):  
Steven M. Olsen ◽  
Eric J. Moore ◽  
Rebecca R. Laborde ◽  
Joaquin J. Garcia ◽  
Jeffrey R. Janus ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Human Papillomavirus ◽  
Robotic Surgery ◽  
Cell Carcinoma ◽  
Neck Dissection ◽  
Transoral Robotic Surgery ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Disease Specific

The aim of this retrospective study was to describe the oncologic and functional results of treating oropharyngeal squamous cell carcinoma with transoral robotic surgery and neck dissection as monotherapy. A review was performed, including all patients who underwent transoral robotic surgery and neck dissection as the only means of therapy for oropharyngeal carcinoma from March 2007 to July 2009 at a single tertiary care academic medical center. We reviewed all cases with ≥ 24-month follow-up. Functional outcomes included tracheostomy dependence and oral feeding ability. Oncologic outcomes were stratified by human papillomavirus (HPV) status and tobacco use and included local, regional, and distant disease control, as well as disease-specific and recurrence-free survival. Eighteen patients met study criteria. Ten patients (55.6%) were able to eat orally in the immediate postoperative period, and 8 (44.4%) required a temporary nasogastric tube for a mean duration of 13.6 days (range 3 to 24 days) before returning to an oral diet. No patient required placement of a gastrostomy tube, and all patients are tracheostomy-tube–free. Among the HPV-positive nonsmokers (12/18, 66.7%), Kaplan-Meier estimated 3-year local, regional, and distant control rates were 90.9%, 100%, and 100%, respectively. Kaplan-Meier estimated disease-specific survival and recurrence-free survival were 100% and 90.9%, respectively. No complications occurred.

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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