Current Indications for Transoral Robotic Surgery in Oropharyngeal Cancer

Parhar, Harman S.; Yver, Christina M.; Brody, Robert M.

doi:10.1016/j.otc.2020.07.007

Cited by 11 publications

(16 citation statements)

References 99 publications

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“…10 Notably, this study period occurred between 1985 and 2005, prior to the development of TORS, which gained US Food and Drug Administration approval for T1 and T2 tumors and has expanded minimally invasive access to the oropharynx. 7 Excellent outcomes in OPSCC have been also reported with transoral laser microsurgery, although widespread national use has not been adopted as with TORS. 7,11,12 Nationally, the use of TORS in OPSCC has been increasing, and this study indicates increasing national utilization of TORS in OPSGM as well.…”

Section: Discussionmentioning

confidence: 99%

“…7 Excellent outcomes in OPSCC have been also reported with transoral laser microsurgery, although widespread national use has not been adopted as with TORS. 7,11,12 Nationally, the use of TORS in OPSCC has been increasing, and this study indicates increasing national utilization of TORS in OPSGM as well. 13 The distribution of affected oropharyngeal subsites in OPSGM differs from OPSCC.…”

Section: Discussionmentioning

confidence: 99%

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National Analysis of Oropharyngeal Salivary Gland Malignancies Treated With Transoral Robotic Surgery

Bollig

Wang

Llerena

et al. 2021

Otolaryngol.--head neck surg.

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Objectives (1) To compare perioperative outcomes and overall survival of patients with oropharyngeal salivary gland malignancies (OPSGMs) treated with transoral robotic surgery (TORS) versus other approaches. (2) To identify clinical factors associated with a robotic surgical approach. Study Design Retrospective analysis of the National Cancer Database (NCDB). Setting NCDB. Methods Data obtained from the NCDB were analyzed between 2010 and 2017 for patients with T1-T4a OPSGMs without distant metastases treated surgically. Patients were stratified by surgical approach (TORS vs nonrobotic), and clinicopathologic factors were compared with the t test or chi-square test for continuous or categorical variables, respectively. Overall survival was analyzed by patient demographics and clinical factors according to Kaplan-Meier and Cox proportional hazards models. Factors associated with TORS were assessed with logistic regression. Results A total of 785 patients were analyzed. A non–soft palate primary site (odds ratio, 12.9; 95% CI, 6.6-25.2) and treatment at an academic facility (odds ratio, 2.0; 95% CI, 1.2-3.5) were independently associated with TORS. There were no significant differences in the positive margin rate, 30-day mortality, or overall survival between the groups. The 30-day unplanned readmission rate was higher in patients treated with TORS versus nonrobotic resections (5.8% vs 1.7%, P = .0004). When stratified by tumor subsite, there was a significant decrease in hospital length of stay in patients with tongue base tumors undergoing TORS versus nonrobotic resections ( P = .029). Conclusion This study suggests that TORS may be a viable treatment modality for appropriately selected patients with OPSGM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

National Analysis of Oropharyngeal Salivary Gland Malignancies Treated With Transoral Robotic Surgery

Bollig

Wang

Llerena

et al. 2021

Otolaryngol.--head neck surg.

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“…Among properly selected OPSCC patients, complication rates of TORS are acceptably low. 62 A recent systematic review reports a postoperative hemorrhage rate of 2.4%, a pharyngocutaneous fistula rate of 2.5%, and a neck hematoma rate of 0.4%. 43…”

Section: Surgical Principles and Patient Selection Considerationsmentioning

confidence: 99%

Patient Selection for Transoral Robotic Surgery (TORS) in Oropharyngeal Squamous Cell Carcinoma

Bunch

Patwa

Hughes

et al. 2021

Topics in Magnetic Resonance Imaging

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Transoral robotic surgery (TORS) is an excellent treatment strategy for well-selected patients with oropharyngeal squamous cell carcinoma. Potential benefits of TORS are greatest among patients for whom surgical resection will reduce or eliminate the need for adjuvant therapy. Proper patient selection largely depends on imaging, which is used to determine tumor resectability, to inform expected morbidity and functional outcome, to assess the potential need for adjuvant therapy, to evaluate for vascular or other anatomic contraindications, and to gauge adequacy of transoral access to the tumor. This article provides the radiologist with a practical and accessible approach to interpreting preoperative imaging among patients with oropharyngeal cancer, emphasizing what the surgeon wants to know to inform the determination of whether the patient is a TORS candidate and why this information is important. By accurately reporting this information, the radiologist facilitates the multidisciplinary care team's selection of a treatment regimen optimized for the circumstances of the individual patient.

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“…It has become adopted at many centers nationally, predominantly for HPV‐positive OPC. In that population, TORS and radiation therapy based treatment have generally been shown to have similar oncologic outcomes; however, this question has not been as thoroughly investigated in HPV‐negative OPC 4–8 . Biologically, HPV‐negative tumors are more radioresistant than their HPV‐positive counterparts, which has translated to worse oncologic outcomes in the former group 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…In that population, TORS and radiation therapy based treatment have generally been shown to have similar oncologic outcomes; however, this question has not been as thoroughly investigated in HPV-negative OPC. [4][5][6][7][8] Biologically, HPVnegative tumors are more radioresistant than their HPVpositive counterparts, which has translated to worse oncologic outcomes in the former group. 9,10 In an attempt to better define the role for treatment intensification in this population, a randomized trial of transoral surgery (RTOG 1221) was initiated, but failed to accrue.…”

Section: Introductionmentioning

confidence: 99%

Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus‐negative oropharyngeal cancer

2022

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Background: Surgery + adjuvant therapy was shown to have improved overall survival (OS) versus nonsurgical treatment in T1-T2N1-N2b human papillomavirus (HPV)-negative oropharyngeal cancer (OPC). Our objective was to compare OS in transoral robotic surgery (TORS) with neck dissection versus nonsurgical treatment for T1-T2N0 HPV-negative OPC. Methods: Patients with T1-T2N0 HPV-negative OPC were identified in the National Cancer Database. OS was compared between groups: (1) TORS with neck dissection +/À adjuvant therapy, (2) primary radiotherapy (>60 Gy) +/À chemotherapy using Kaplan-Meier and multivariable Cox proportional hazards models. Results: There were 665 (78.4%) patients treated nonsurgically and 183 (21.6%) patients in the TORS group. Adjusting for age, comorbidity score, facility type, tumor subsite, and tumor stage, primary nonsurgical treatment was associated with worse OS (hazard ratio: 1.90, 95% CI: 1.34-2.69). Conclusion:For T1-T2N0 HPV-negative OPC, TORS with neck dissection may be associated with a survival benefit over nonsurgical treatment.

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Current Indications for Transoral Robotic Surgery in Oropharyngeal Cancer

Cited by 11 publications

References 99 publications

National Analysis of Oropharyngeal Salivary Gland Malignancies Treated With Transoral Robotic Surgery

National Analysis of Oropharyngeal Salivary Gland Malignancies Treated With Transoral Robotic Surgery

Patient Selection for Transoral Robotic Surgery (TORS) in Oropharyngeal Squamous Cell Carcinoma

Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus‐negative oropharyngeal cancer

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