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

Abstract

Background: We assessed long-term patient-reported dysphagia and xerostomia outcomes following definitive surgical management with transoral robotic surgery (TORS) in patients with oropharyngeal cancer (OPC) via a cross-sectional survey study. Methods: Patients with OPC managed with primary oropharyngeal surgery as definitive treatment at least 1 year ago between 2015 and 2019 were identified. The M. D. Anderson Dysphagia Inventory (MDADI) and Xerostomia Inventory (XI) scores were compared across treatment types (i.e., no adjuvant therapy [TORS-A] vs. adjuvant radiotherapy [TORS+RT] vs. adjuvant chemoradiotherapy [TORS+CT/RT]). Results: The sample had 62 patients (10 TORS-A, 30 TORS+RT, 22 TORS +CT/RT). TORS-A had clinically and statistically significantly better MDADI scores than TORS+RT (p = 0.03) and TORS+CT/RT (p = 0.02), but TORS +RT and TORS+CT/RT were not significantly different. TORS-A had clinically and statistically significantly less XI than TORS+RT (p < 0.01) and TORS +CT/RT (p < 0.01). Conclusions: Patients with OPC who have undergone TORS+RT or TORS +CT/RT following surgery face clinically worse dysphagia and xerostomia outcomes relative to patients who undergo TORS-A.

A Descriptive Study of Quality of Life Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma

“… 37 - 39 Other research exploring the effects of adjuvant treatments on dysphagia-related QOL also note unfavorable findings. 40 - 43 Specifically, a cross-sectional study of OPSCC patients undergoing TORS found that those not necessitating adjuvant therapy (n = 10) had significantly better Xerostomia Index scores and dysphagia-related QOL in the composite, physical, and emotional subdomains of the MD Anderson Dysphagia Inventory compared to those receiving adjuvant RT (n = 30) and CRT (n = 22). 40 Post-RT, dysphagia may be due to fibrosis causing poor tongue base mobility and poor contact to the posterior pharyngeal wall, impaired laryngeal elevation, and reduced vestibule and true vocal cord closure during the swallow.…”

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

“…[16][17][18][19] However, all of these studies are limited by inclusion of open surgeries or patients with HPV-negative disease, consist of small sample sizes, and have potentially omitted recent advances in radiotherapy treatment techniques. 17,18,[20][21][22] In a 2015 systematic review, Hutcheson, et al summarized the literature related to functional outcomes and found that none of the studies included in the analysis stratified patients by HPV status. These toxicities described for TMT may be less relevant for the healthier, HPV-positive population with fewer baseline comorbidities.…”

“…TMT for HPV+ OPSCC is currently viewed as a highly undesirable outcome based on evidence that it produces worse treatment‐related toxicities, including dysphagia, xerostomia, and increased feeding tube dependence when compared to primary chemoradiation alone 16–19 . However, all of these studies are limited by inclusion of open surgeries or patients with HPV‐negative disease, consist of small sample sizes, and have potentially omitted recent advances in radiotherapy treatment techniques 17,18,20–22 . In a 2015 systematic review, Hutcheson, et al summarized the literature related to functional outcomes and found that none of the studies included in the analysis stratified patients by HPV status.…”

National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

“…2 While, to our knowledge, no phase 3 randomized clinical trials have been conducted to compare treatment modalities, retrospective studies and phase 2 trials suggest similar oncologic outcomes for these treatment approaches. 3,4 There is conflicting evidence in regard to functional outcomes with surgical vs nonsurgical approaches 5,6 ; however, patients with oropharynx cancer managed with surgery alone have more favorable swallowing outcomes, 4,7 and an increasing number of patients are being treated with upfront surgery. 8,9 Surgical approaches to the oropharynx include minimally invasive techniques with transoral laser microsurgery and transoral robotic surgery (TORS), as well as open procedures.…”