Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS)

Cannon, Richard B.; Houlton, Jeffrey; Patel, Seraphim; Raju, Sharat; Noble, A. D.; Futran, Neal D.; Parvathaneni, Upendra; Méndez, Eduardo

doi:10.1016/j.oraloncology.2018.10.001

Cited by 27 publications

(45 citation statements)

References 24 publications

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“…A paradoxical fact on recommendations for margin width lies in the techniquedependent threshold defining "clear margins". A cancer of the upper aerodigestive tract would be defined as completely resected with a threshold of 5 mm of pathologically uninvolved tissue if operated on with open surgery, 2-5 mm if through transoral robotic surgery, 0.5-2 mm if via transoral laser surgery, and regardless of metric measurements provided that adjacent structures are not infiltrated in case endoscopic transnasal resection has been performed [27][28][29][30][31][32][33][34][35][36]. On the one hand, this difference is understandable as it expresses the need to define as either "adequate" or "inadequate" a resection performed with a given technique.…”

Section: Practical Determinants Of Marginmentioning

confidence: 99%

Novel Approaches in Surgical Management: How to Assess Surgical Margins

Ferrari

Montalto

Nicolai

2021

Critical Issues in Head and Neck Oncology

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The concept of surgical margins was born a long time ago but still lacks a univocal and sound understanding. The current biological rationale behind the recommendations on margins management relies on two pillars: (1) the observation that groups of cancer cells can leave the macroscopic tumor and disseminate throughout adjacent tissues with different degrees of aggressiveness; (2) the belief that removal of all (or most of) cancer cells can cure the patient. However, this background is undermined by some pieces of evidence. For instance, it has been proven that tissues surrounding cancer often bear precancerous traits, which means that cutting through non-cancerous tissues does not equate to cut through healthy tissues. The head and neck exquisitely poses a number of challenges in the achievement of negative margins, with special reference to anatomical complexity, high density in relevant structures, and unique histological heterogeneity of cancers. Currently, intraoperative margins evaluation relies on surgeons’ sight, palpation, ability to map tumor extension on imaging, and knowledge of anatomy, with some optical imaging technologies aiding the delineation of the mucosal margins of excision. Frozen sections are currently used to intraoperatively evaluate margins, yet with debate on whether and how this practice should be performed. Future perspectives on improvement of margins control are threefold: research is oriented towards refinements of understanding of cancers local progression, implementation of technologies to intraoperatively render tumor extension, and employment of optical imaging modalities capable of detecting foci of residual tumor in the surgical bed.

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Section: Practical Determinants Of Marginmentioning

confidence: 99%

Novel Approaches in Surgical Management: How to Assess Surgical Margins

Ferrari

Montalto

Nicolai

2021

Critical Issues in Head and Neck Oncology

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“…2,5,10,11 Reported frequencies of all LN metastasis are 76%-90% for level II, 22%-50% for level III and 9%-14% for level IV. [5][6][7][8]11 Our frequencies correspond to Amsbaugh all level IV pN + ve disease was occult (see Table 3).…”

Section: Discussionmentioning

confidence: 88%

The frequency of lymph node metastases by neck level in p16 positive oropharyngeal squamous cell carcinoma

Green

Moustafa

Chengot

et al. 2020

Clinical Otolaryngology

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“…Figure displays the results of the review process in a PRISMA flowchart. On detailed review of full text articles, many records were ineligible as they were review articles, did not report any TORS salvage cases, the salvage cases were indistinguishable from the primary cases/combined cohort, there were insufficient survival data, reports were only conference abstracts, related to nasopharyngeal carcinoma only, or the reports were superseded by more contemporary publications from the relevant institutions . A total of eight studies met the eligibility criteria and have been presented in the results …”

Section: Resultsmentioning

confidence: 99%

Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis

et al. 2020

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Background Transoral robotic surgery (TORS) for recurrent head and neck (H&N) cancer is an emerging but relatively infrequent procedure. Methods Systematic review and meta‐analysis of studies reporting survival data and functional outcomes for patients undergoing TORS for previously treated H&N cancers. Results Eight hundred seventy‐eight records were identified, of which eight were eligible for inclusion, covering 161 cases (range 1‐64). The pooled rates were as follows: 2‐year overall survival 73.8% (4 studies, range 70.6‐75.0, 95% confidence intervals (CI) 65.4 to 81.5, [I2 0.0%, P = 1.0]); 2‐year disease‐free survival 74.8% (4 studies, range 56.2‐92.0, 95% CI 63.3 to 84.8, [I2 36.9%, P = .2]); postoperative hemorrhage 9.3% (4 studies, range 3.3‐13.3, 95% CI 4.7 to 15.1, [I2 0.0%, P = .5]). Conclusions Functional and oncological outcomes are favorable, although the follow‐up is limited in the literature. Larger cohorts with longer follow‐up are needed for definitive conclusions to be drawn.

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Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS)

Cited by 27 publications

References 24 publications

Novel Approaches in Surgical Management: How to Assess Surgical Margins

Novel Approaches in Surgical Management: How to Assess Surgical Margins

The frequency of lymph node metastases by neck level in p16 positive oropharyngeal squamous cell carcinoma

Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis

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