Comparison of functional and oncological treatment outcomes after transoral robotic surgery and open surgery for supraglottic laryngeal cancer

Karabulut, Burak; Deveci, İldem; Sürmeli, Mehmet; Sahin-Yilmaz, Aslı; Oysu, Çağatay

doi:10.1017/s0022215118001305

Cited by 16 publications

(16 citation statements)

References 12 publications

(23 reference statements)

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“…It is also of interest when comparing the functional and oncological results of open supraglottic laryngectomy and transoral robotic supraglottic laryngectomy. While there are no differences in overall survival time and disease-specific survival time between groups, the open access operated cohort had a longer oral feeding time, hospitalization and recovery period [ 18 ]. With this knowledge, the goal must be to enable noninvasive surgery for patients who are not treatable by TLM and conventional TORS, such as with the DaVinci System.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a curved surgical prototype in a human larynx

Schild

Böhm

Kienle

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose It is not always possible to create linear access to the larynx using a rigid operating laryngoscope for microlaryngoscopy. In this study, we evaluate the usability of a novel curved surgical prototype with flexible instruments for the larynx (sMAC) in a simulation dummy and human body donor. Methods In a user study (n = 6), head and neck surgeons as well as medical students tested the system for visualization quality and accessibility of laryngeal landmarks on an intubation dummy and human cadaver. A biopsy of the epiglottis was taken from the body donor. Photographic and time documentation was carried out. Results The sMAC system demonstrated general feasibility for laryngeal surgery. Unlike conventional microlaryngoscopy, all landmarks could be visualized and manipulated in both setups. Biopsy removal was possible. Visibility of the surgical field remained largely unobstructed even with an endotracheal tube in place. Overall handling of the sMAC prototype was satisfactorily feasible at all times. Conclusion The sMAC system could offer an alternative for patients, where microlaryngoscopy is not applicable. A clinical trial has to clarify if the system benefits in clinical routine.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a curved surgical prototype in a human larynx

Schild

Böhm

Kienle

et al. 2021

Eur Arch Otorhinolaryngol

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“…Ansarin et al reported an OS of 100% for TORS in T1‐3 supraglottic cancer, although they were also limited by short follow‐up times and a small cohort of 10 patients . Karabulut et al compared TORS to open surgery in supraglottic tumors and found no difference in OS with a mean follow‐up of 26 months . Finally, Kayhan et al reported an OS of 97.9% for TORS in 48 patients with early glottic cancer, and Doazan et al found a 5‐year OS of 78.7% in a multicenter study of 122 supraglottic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Despite increased use in laryngeal cancer, there are only a handful of single‐institution studies examining oncologic outcomes following TORS for laryngeal cancer. Those that exist have limited follow‐up, usually <3 years . Furthermore, most of these studies are conducted by high‐volume TORS centers, which creates the potential for publication bias in the literature.…”

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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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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“…In the recent 20 years, the management of advanced larynx cancer underwent a significant evolution, and a gradual shift has been described from operative to nonoperative treatment [ 1 , 3 ]. However, the CRT is associated with several significant side effects, including severe mucositis, pain, and dysphagia [ 4 , 5 ]. Due to the significant toxicity of CRT regimens, there has been a resurgence of interest in the primary surgical management of patients with head and neck cancer [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Transoral Laser-Assisted Total Laryngectomy: Expanding the TLM’s World

Ahmadi¹,

Mohebbi²,

Kazemi

et al. 2020

Case Reports in Otolaryngology

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Introduction. The introduction of laryngeal transoral procedures has created a shift in the treatment of laryngeal cancers towards the primary surgical management of patients. In this study, we aimed to evaluate the safety, efficacy, and feasibility of the transoral laser-assisted total laryngectomy (TLM-TL) in advanced laryngeal cancer. Case presentation. In this case report, we describe a case of a 50-year-old male patient presented to the otorhinolaryngology clinic with a history of hoarseness and odynophagia since 6 months. Based on the pathological and imaging findings, the diagnosis of stage IVa laryngeal squamous cell carcinoma with the involvement of the base, tongue, and left palatine tonsil was made for the patient, and transoral total laryngectomy with partial glossectomy via the TLM technique was planned. Result. The tumor was successfully resected by TLM-TL with clear surgical margins. No complication was observed after the surgery. Good functional recovery was obtained regarding swallowing and speech. The patient’s oncologic and functional outcomes were evaluated for 2 years. Everything was satisfactory with good long-term cosmetic and laryngopharyngeal functional outcome and no sign of tumor recurrence. Conclusions. TLM-TL is a minimally invasive and cost-benefit endoscopic surgical procedure feasible in advanced laryngeal cancer with good long-term oncological and functional outcome. It could limit postoperative complications, mainly the incidence of pharyngocutaneous fistulae. It is also associated with better satisfaction after TL due to cosmetic benefits.

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Comparison of functional and oncological treatment outcomes after transoral robotic surgery and open surgery for supraglottic laryngeal cancer

Abstract: Transoral robotic supraglottic laryngectomy for supraglottic laryngeal cancer is an oncologically safe and functional procedure with better results when compared to conventional open surgery.

Cited by 16 publications

References 12 publications

Evaluation of a curved surgical prototype in a human larynx

Evaluation of a curved surgical prototype in a human larynx

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

Transoral Laser-Assisted Total Laryngectomy: Expanding the TLM’s World

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