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

Abstract

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.

Evaluation of a curved surgical prototype in a human larynx

“…In the treatment of early staged (T1–T2) (supra)glottic carcinoma radio-chemotherapy and surgical treatment, especially TLM, are considered as standard treatments, which offer similar (good) results in oncological outcome [ 11 ]. In one of the few directly comparative retrospective databases analysis studies, Hanna et al showed that also transoral robotic surgery (TORS) can achieve competitive oncological results, since there was no observed difference in margin status and necessitating adjuvant radiation compared to TLM [ 12 ].…”

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“…A further evaluation was subsequently carried out by Hanna et al to compare negative margins and overall survival rates between patients undergoing TORS, TLM, and conventional trans-oral surgery. 15 This retrospective analysis of 1780 patients in the US National Cancer Database with T1 and 2 laryngeal squamous cell carcinoma found that TORS patients had a lower rate of positive margins than open surgery (when compared to open surgery [TORS: HR 1.56, p = 0.05], [TLM: HR 1.52, p = 0.05]). The highest 5-year overall survival was in the TORS cohort.…”

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“…Am häufigsten kommt die TORS außerhalb des Oropharynx bei der Resektion von supraglottischen Larynxkarzinomen zum Einsatz [200]. Eine aktuelle Meta-Analyse von Lechien und Co-Autoren an 422 Patienten mit supraglottischen Larynxkarzinomen zeigt gute onkologische Ergebnisse nach TORS mit dem da Vinci-System mit 5-Jahres rezidivfreien Überlebensraten von über 90 % [201].…”

“…Outside the oropharynx, TORS is most commonly used for the resection of supraglottic laryngeal carcinomas [200]. A recent metaanalysis by Lechien and co-authors on 422 patients with supraglottic laryngeal carcinomas showed good oncologic outcomes after TORS with the da Vinci system with 5-year recurrence-free survival rates of more than 90 % [201].…”

“…Prospective studies comparing TORS for supraglottic laryngeal carcinomas with open surgical procedures or primary radiotherapy are currently not available. However, retrospective comparisons suggest that for carefully selected patients, TORS offers equivalent oncologic outcomes compared with open surgery [200,202]. Regarding peri-and post-operative complications, the above-mentioned meta-analysis reported a most likely aspiration-related pneumonia rate of 17.9 %.…”