Oncologic outcomes with transoral robotic surgery for supraglottic squamous cell carcinoma: Results of the French Robotic Surgery Group of GETTEC

Doazan, Marianne; Hans, Stéphane; Morinière, S.; Lallemant, Benjamin; Vergez, S.; Aubry, Karine; Monès, Erwan de; Espitalier, F.; Jégoux, Franck; Pradat, Pierre; Céruse, Philippe

doi:10.1002/hed.25199

Cited by 32 publications

(27 citation statements)

References 46 publications

(78 reference statements)

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“…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. It is notable that the largest study yielded a 5‐year OS most closely resembling the rate in this study . The difference between the results of this study and that of Doazan et al is potentially explained by the inclusion of only supraglottic cancer patients in their study.…”

Section: Discussioncontrasting

confidence: 46%

“…Although primarily utilized and approved by the Food and Drug Administration (FDA) for the oropharynx, TORS is increasingly employed in the treatment of laryngeal cancer, predominantly for supraglottic tumors, although several studies suggest that even glottic lesions are being treated with TORS . Several early studies have demonstrated promising results, showing similar oncologic outcomes to other surgical modalities and primary radiation therapy . Given that recent studies have questioned functional outcomes following chemoradiation of the larynx, the potential for functional preservation has fueled interest in utilizing TORS for laryngeal surgery …”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 46%

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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“…In 2009, the U.S. Food and Drug Administration approved use of the da Vinci surgical robot for TORS early cancers (cT1 and cT2) of the oral cavity, larynx, and oropharynx. However, some selected patients with cT3 or cT4 would benefit from TORS cancer resection, but few data are currently available in the literature 7 . Moreover, there are few data about oncological outcomes associated with TORS SGL 3,7–11 …”

Section: Introductionmentioning

confidence: 99%

Surgical, Oncological, and Functional Outcomes of Transoral Robotic Supraglottic Laryngectomy

et al. 2020

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Objectives/Hypothesis To investigate the surgical, oncological, and functional outcomes of transoral robotic surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. Study Design Retrospective chart review. Methods The charts of patients treated by TORS supraglottic laryngectomy (SGL) in an academic medical center were reviewed. The following outcomes were studied according to the tumor location: average robotic setup and operative times, mean estimated blood loss, postoperative complications, need of tracheotomy, refeeding characteristics, mean hospital stay, need of neck dissection and adjuvant therapy, 5‐year local and regional controls, overall survival (OS), and disease‐free survival (DFS). Results Seventy‐five patients underwent TORS SGL. Tumors were classified as cT1 (32%), cT2 (52%), and cT3 (16%). Average robotic setup and operative times and the mean estimated blood loss were 15 minutes, 55 minutes, and 20 mL, respectively. The mean follow‐up period ranged from 2 to 5 years. The 5‐year OS and DFS were 80.2% and 94.3%, respectively. Overall, 34.6% of patients received adjuvant radiotherapy. The majority of patients (92%) restarted an oral diet within 24 to 48 hours postsurgery. Transient tracheotomy was performed in 8% of patients. Postoperative hemorrhages occurred in 12 patients (16.0%), lengthening the hospital stay (mean = 6.8 days). There were no outcome differences regarding the tumor location. Conclusions TORS is an effective and safe therapeutic approach for early‐ and intermediate‐stages cancers. Oncological outcomes may be quite similar to other surgical approaches, including transoral laser and open surgeries. Future randomized controlled studies are needed for comparing TORS SGL with other surgical procedures. Level of Evidence 4 Laryngoscope, 131:1060–1065, 2021

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“…Doazan et al . ( 32 ) reported 2 deaths because of postoperative hemorrhage (1.6%). This rate is higher than what was reported for the series of Mandal et al .…”

Section: Discussionmentioning

confidence: 99%

Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature

Roselló¹,

Albuquerque²,

Roselló-Llabrés³

et al. 2020

Med Oral

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Background TORS has become one of the latest surgical alternatives in the treatment of oropharynx squamous cell carcinomas (OPSCC) and has become increasingly accepted by surgeons as a treatment option. Surgical robots were designed for various purposes, such as allowing remote telesurgery, and eliminating human factors like trembling. The study aimed to compare systematic review of the available literature in order to evaluate the safety and efficacy of Transoral Robotic Surgery (TORS) compared with open surgery. Material and Methods We performed a systematic review of the available literature in order to evaluate the safety and effectiveness of TORS compared with open surgery. We compared TORS and open surgery based on 16 outcomes divided in to 3 groups: intra-operative complications, post-operative complications, and functional and oncologic outcomes. An electronic search of observational studies was carried out using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Oral Health Group Trials Register, and Scielo. Data analysis was carried out in accordance to Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) and the quality of the studies were evaluated using the Newcastle-Ottawa Scale. No language restrictions were imposed. Results From the 4 studies identified (Newcastle-Ottawa Scale mean score 6.5), 371 patients were revised (186 patients were treated with TORS and 185 with conventional surgery). Overall, TORS, when compared with open surgery, appears to have better functional results (less hospital time, decannulation) and fewer intraoperative and post-operative complications. There is no significant difference when assessing the oncological outcomes (positive margins, survival rate) when comparing both techniques. Conclusions TORS has an overall better functional outcome, and less intraoperative and postoperative complications with no difference in positive margins and survival rate when compared with conventional therapy. Key words: Transoral Robotic Surgery, TORS, open surgery, conventional surgery, head and neck cancer, oral cancer.

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Oncologic outcomes with transoral robotic surgery for supraglottic squamous cell carcinoma: Results of the French Robotic Surgery Group of GETTEC

Abstract: Local control rate after TORS SGL was at least equivalent to what has been described in the literature for open or transoral laser surgery, or with radiotherapy. Using TORS seems to be an effective therapeutic treatment of early-stage and intermediate-stage supraglottic SCCs.

Cited by 32 publications

References 46 publications

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

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

Surgical, Oncological, and Functional Outcomes of Transoral Robotic Supraglottic Laryngectomy

Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature

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