A Contemporary Review of Evidence for Transoral Robotic Surgery in Laryngeal Cancer

Gorphe, Philippe

doi:10.3389/fonc.2018.00121

Cited by 41 publications

(46 citation statements)

References 54 publications

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“…Given the lack of observed difference between TORS and more established modalities at achieving negative margins and necessitating adjuvant radiation, and given that TORS performed no worse than open surgery with respect to OS in supraglottic patients, we suggest that TORS may be a viable option in the treatment of early‐stage laryngeal cancer, especially of the supraglottis. This is the first study to compare oncologic outcomes in laryngeal malignancies treated with TORS or TLM …”

Section: Discussionmentioning

confidence: 99%

“…Although primarily utilized and approved by the Food and Drug Administration (FDA) for the oropharynx, TORS is increasingly employed in the treatment of laryngeal cancer, predominantly for supraglottic tumors, although several studies suggest that even glottic lesions are being treated with TORS . Several early studies have demonstrated promising results, showing similar oncologic outcomes to other surgical modalities and primary radiation therapy .…”

Section: Introductionmentioning

confidence: 99%

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Is robotic surgery an option for early T‐stage laryngeal cancer? Early nationwide results

et al. 2019

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Objectives/Hypothesis: To characterize patients undergoing laryngeal transoral robotic surgery (TORS) and compare to open partial surgery and transoral laser microsurgery (TLM) in achieving negative margins, requiring adjuvant radiation, and overall survival. Study Design: Retrospective database analysis. Methods: Early-stage (T1/2) laryngeal squamous cell carcinoma patients from the National Cancer Database. Univariable and multivariable logistic and Cox regressions were used to identify predictors. Results: There were 1,780 patients included in the study (186 [10.4%] = TORS; 523 [29.4%] = open surgery; 1,071 [60.2%] = TLM). TORS was more commonly treated at academic centers (68.8% = open surgery, 53.9% = TLM, 71.0% = TORS; P < .001) and had more T2 (52.7% = TORS, 46.7% = open surgery, 20.5% = TLM; P < .001) and N-positive disease (26.9% = TORS, 19.5% = open surgery, 5.5% = TLM; P < .001). Surgical approach was significantly associated with margin status (positive margin rates: TORS = 17.4%, TLM = 20.0%, open surgery = 13.8%) between open surgery and TLM in multivariable analysis (compared to open surgery, TLM: 1.63 [1.12-2.38], TORS: 1.18 [0.72-1.94]; P = .04). Surgical approach was not associated with receipt of adjuvant radiation (compared to open surgery, TLM: 1.52 [1.04-2.24], TORS: 1.56 [0.97-2.49]; P = .05). It was not associated with margins or adjuvant radiation in supraglottic patients. TORS had the highest 5-year overall survival, although the survival for TLM was similar (68.7% and 64.8%, respectively), and both were higher than that of open surgery (59.1%; P = .01). In multivariable Cox regression for supraglottic patients, there was no observed difference between TORS and open surgery (compared to TORS, open surgery: 1.44 [0.93-2.24]; P = .25). Conclusions: On multivariable analysis, there was no observed difference in margin status in TORS patients compared to TLM and open surgery (in both the total cohort and supraglottic subgroup). Similarly there was no observed difference in necessitating adjuvant radiation. In Cox regression, there was no observed difference between TORS and open surgery in overall survival for supraglottic patients. This study suggests that TORS may be a viable treatment option for early-stage laryngeal cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is robotic surgery an option for early T‐stage laryngeal cancer? Early nationwide results

et al. 2019

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“…Clear margins are difficult to attain in these situations. There is currently limited data on this subsite for TORS …”

Section: Laryngeal Diseasementioning

confidence: 99%

Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup

et al. 2019

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The objective of this article was to review the indications for transoral robotic surgery (TORS) in head and neck malignancies. The role of imaging in patient selection will be specifically reviewed. TORS is a recently developed technique that allows minimally invasive surgeries to be performed in the head and neck. TORS has a role in the de‐escalation of oropharyngeal cancers, which allows for lower doses of chemoradiation therapy (this is a technique currently in clinical trials). Additionally, this technique allows for less invasive surgery and decreases associated complications. TORS can also be performed at other subsites. Cross‐sectional imaging has a prominent role to help identify suitable candidates for this type of surgery. This article will review important anatomy and staging related to TORS. Additionally, the key imaging features for patient selection (indications and contraindications) will be presented along with case illustrations.

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“…More recently, transoral surgery, including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), has enabled oncologic surgeons to remove early stage LC without opening the upper aerodigestive tract, hence avoiding complications related to conventional open surgery (scar, salivary fistula, infection, etc.) and enabling faster functional recovery, particularly regarding swallowing [5,6]. However, even when the primary tumor is removed by TLM or TORS, neck dissection has to be performed when indicated, and in particular for supraglottic cancer or glottic cancer invading the supraglottic area due to the risk of lymph node involvement [3,6].…”

Section: Introductionmentioning

confidence: 99%

“…and enabling faster functional recovery, particularly regarding swallowing [5,6]. However, even when the primary tumor is removed by TLM or TORS, neck dissection has to be performed when indicated, and in particular for supraglottic cancer or glottic cancer invading the supraglottic area due to the risk of lymph node involvement [3,6]. At the same time, advances in radiotherapy (RT) techniques and, notably, the development of intensity-modulated radiation therapy (IMRT), have considerably reduced late side-effects of HNSCC RT [7].…”

Section: Introductionmentioning

confidence: 99%

Current Role of Total Laryngectomy in the Era of Organ Preservation

Bozec

Culié

Poissonnet

et al. 2020

Cancers

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In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.

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A Contemporary Review of Evidence for Transoral Robotic Surgery in Laryngeal Cancer

Cited by 41 publications

References 54 publications

Is robotic surgery an option for early T‐stage laryngeal cancer? Early nationwide results

Is robotic surgery an option for early T‐stage laryngeal cancer? Early nationwide results

Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup

Current Role of Total Laryngectomy in the Era of Organ Preservation

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