Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions

Abstract

The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends.

Impact of Human Papillomavirus on Oropharyngeal Cancer Biology and Response to Therapy

“…Alternatively, TORS provides improved surgical access to the oropharynx and enhanced visual evaluation of margins due to improved infield optics, 3-dimensional imagery, tremor filtration and high-precision movements, although at increased cost. 54,55 TORS shows promising oncologic outcomes demonstrated by the 1– and 2–year OS rates of 90% and 80–90%, respectively, in the initial retrospective studies on highly selected patients. 54 TORS offers the additional benefit of complete pathologic staging information via en bloc resection with markedly decreased morbidity compared to CRT regimens.…”

Oral complications of cancer and cancer therapy

“…4 Transoral robotic surgery and transoral laser microsurgery offer a surgical alternative to CRT-based organ preservation strategies, and several series have shown comparable oncologic outcomes with superior functional results using these surgical approaches. 5 This is because robotic technology provides improved visual access and the ability to manipulate the tissue in a way that cannot be accomplished using nonrobotic transoral techniques.…”

“…14,56,76 Severe mucositis (grade [3][4] occurs in 34% of patients receiving standard RT and in over 56% of patients receiving AF-RT. 77 Concomitant CRT further increases grade 3 or 4 mucositis; incidence rates range from 50% to 100% depending on the regimen.…”

Robotic Selective Neck Dissection Using a Gasless Postauricular Facelift Approach for Early Head and Neck Cancer: Technical Feasibility and Safety

“…1 Since then, various endoscopic or robotic thyroidectomy techniques have been developed to avoid scars and improve postoperative cosmesis in the neck, including cervical, anterior chest, breast, axilla, and postauricular approaches, along with modifications and combinations of these techniques. [2][3][4][5][6][7][8] Some surgeons have pioneered endoscopic or robot-assisted lateral neck dissection via a transaxillary or breast approach in thyroid cancer patients and demonstrated that these approaches are feasible and safe. 9, 10 We have developed a technique of robotic selective neck dissection via a gasless postauricular facelift approach using the da Vinci Ò Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) for the management of cervical lymph node metastasis in early head and neck cancer in a way that avoids a long visible scar in the neck.…”