Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

Hanna, Jonathan; Morse, Elliot; Brauer, Philip R.; Judson, Benjamin L.; Mehra, Saral

doi:10.1002/hed.25792

Cited by 27 publications

(28 citation statements)

References 28 publications

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“…TORS should continue to be performed at high-volume centers, and our study demonstrates that treatment at a high-volume center is associated with a decreased risk of positive margins. These results are consistent with prior retrospective studies using the National Cancer Database (NCDB) [19]. In addition, it is encouraging to see that the use of adjuvant therapy decreased as the year of diagnosis increased, possibly a result of increased surgeon comfort with the technique and the robotic device.…”

Section: Discussionsupporting

confidence: 86%

Identification of Clinical and Socioeconomic Predictors of Adjuvant Therapy after Trans-Oral Robotic Surgery in Patients with Oropharyngeal Squamous Cell Carcinoma

Baliga

Klamer

Jhawar

et al. 2020

Cancers

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Trans-oral robotic surgery (TORS) has emerged as an important surgical treatment option in the management of human papillomavirus (HPV)-positive and -negative oropharynx cancer. However, treatment selection is paramount to ensure that patients will not require multimodality adjuvant therapy. In this study, we determined predictors of adjuvant therapy in TORS-treated patients. The National Cancer Database (NCDB) was used to identify patients with newly diagnosed clinical T1-T4, N0-N3 oropharyngeal squamous cell carcinoma who underwent TORS between 2010–2016. Kaplan–Meier survival analysis was used to estimate overall survival (OS). A total of 2999 patients were studied, and the five-year OS for the entire cohort was 82.5%, and for HPV-positive and -negative cohorts it was 88.3% and 67.9%, respectively (p < 0.001). Among all patients treated with TORS, 35.1% of patients received no additional treatment, 33.5% received adjuvant radiation alone (RT), and 31.3% received adjuvant chemoradiation. The N stage was pathologically upstaged in 629 (20.9%) patients after TORS. Patients treated at higher-volume centers were more likely to have negative surgical margins (OR: 0.96, 95% CI: 0.94, 0.98, p < 0.001), but this did not influence the receipt of adjuvant therapy. The high rate of adjuvant multimodality treatment after TORS suggests a need for improved patient selection. Limitations of this study, including lack of data on loco-regional control, progression free survival, acute and late toxicities, and utilization of pretreatment PET/CT imaging, should be addressed in future studies.

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Section: Discussionsupporting

confidence: 86%

Identification of Clinical and Socioeconomic Predictors of Adjuvant Therapy after Trans-Oral Robotic Surgery in Patients with Oropharyngeal Squamous Cell Carcinoma

Baliga

Klamer

Jhawar

et al. 2020

Cancers

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“…In support of this, we note that TORS studies published earlier in the technique's development reported PMRs for base of tongue cancers (18.4%-19.6%) that were substantially higher than the rate we observed at the end of our study period (15.8%). 21,22 This may indicate that TORS outcomes may continue to improve as surgeons gain further expertise with the technique.…”

Section: Discussionmentioning

confidence: 99%

Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers

Oliver

Persky

Wang

et al. 2021

Cancer

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Background Transoral robotic surgery (TORS) was approved by the Food and Drug Administration in 2009 for the treatment of oropharyngeal cancers (oropharyngeal squamous cell carcinoma [OPSCC]). This study investigated the adoption and safety of TORS. Methods All patients who underwent TORS for OPSCC in the National Cancer Data Base from 2010 to 2016 were selected. Trends in the positive margin rate (PMR), 30‐day unplanned readmission, and early postoperative mortality were evaluated. Outcomes after TORS, nonrobotic surgery (NRS), and nonsurgical treatment were compared with matched‐pair survival analyses. Results From 2010 to 2016, among 73,661 patients with OPSCC, 50,643 were treated nonsurgically, 18,024 were treated with NRS, and 4994 were treated with TORS. TORS utilization increased every year from 2010 (n = 363; 4.2%) to 2016 (n = 994; 8.3%). The TORS PMR for base of tongue malignancies decreased significantly over the study period (21.6% in 2010‐2011 vs 15.8% in 2015‐2016; P = .03). The TORS PMR at high‐volume centers (≥10 cases per year; 11.2%) was almost half that of low‐volume centers (<10 cases per year; 19.3%; P < .001). The rates of 30‐day unplanned readmission (4.1%) and 30‐day postoperative mortality (1.0%) after TORS were low and did not vary over time. High‐volume TORS centers had significantly lower rates of 30‐day postoperative mortality than low‐volume centers (0.5% vs 1.5%; P = .006). In matched‐pair analyses controlling for clinicopathologic cofactors, 30‐, 60‐, and 90‐day posttreatment mortality did not vary among patients with OPSCC treated with TORS, NRS, or nonsurgical treatment. Conclusions TORS has become widely adopted and remains safe across the country with a very low risk of severe complications comparable to the risk with NRS. Although safety is excellent nationally, high‐volume TORS centers have superior outcomes with lower rates of positive margins and early postoperative mortality.

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“…TORS has shown preservation of laryngopharyngeal function without compromising oncologic outcomes and has reduced the need for adjuvant therapy using an “inside‐out” approach . In a more recent study, TORS has also been shown to have a lower rate of positive margins when compared to non‐robotic surgery, particularly in high‐volume centers …”

Section: Resultsmentioning

confidence: 99%

Robotic surgery of the anterior skull base

Campbell

2019

Int Forum Allergy Rhinol

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Background: Significant advances have been made in transoral robotic surgery (TORS), yet its application in anterior skull-base surgery has yet to be defined. This work explores the history of endoscopic sinus and anterior skullbase surgery, and its advantages and disadvantages. The development of robotic surgery is then discussed as well as the advantages and disadvantages of TORS as it relates to the anterior skull base. The current applications for robotic surgery to the anterior skull base are presented with details of future applications. Methods:A structured search of the current literature using MEDLINE, PubMed, and EMBASE was performed from inception to May 2019. Search terms related to topics of robotic skull-base surgery were identified and queried to identify relevant articles. Results:Fi y-four papers were identified from the literature search and a hand search of the references. Twentyone other references were discovered from personal communication, websites, and books relevant to the topic. Conclusion:Anterior skull-base surgery has the potential for significant morbidity compared to head and neck surgery, yet the application of the robot in sinus and anterior skull-base surgery has yet to be formally defined. Currently, there are certain limitations that need to be overcome; however, research to address these barriers is currently underway and promises an exciting future for robotic sinus and anterior skull-base surgery. C 2019 ARS-AAOA, LLC.

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Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

Cited by 27 publications

References 28 publications

Identification of Clinical and Socioeconomic Predictors of Adjuvant Therapy after Trans-Oral Robotic Surgery in Patients with Oropharyngeal Squamous Cell Carcinoma

Identification of Clinical and Socioeconomic Predictors of Adjuvant Therapy after Trans-Oral Robotic Surgery in Patients with Oropharyngeal Squamous Cell Carcinoma

Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers

Robotic surgery of the anterior skull base

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