Short-term postoperative distress associated with open vs. transoral robotic surgery (TORS) in patients with T1-T2 carcinomas of the tongue base and supraglottis

Abstract

Background. This study compared the adverse effects of open surgery (OS) including lateral pharyngotomy and supraglottic laryngectomy vs. transoral robotic surgery (TORS) in the treatment of stage T1 and T2 carcinomas of the tongue base and supraglottis. Methods. A retrospective study involving a 49 (13 female and 36 male) patients with untreated T1 or T2 carcinomas. Twenty two were operated on using TORS and 27 underwent conventional OS. The indicators for comparison were: total blood loss during surgery, post-operative pain measured with the Visual Analog Scale (VAS); global, emotional and physical post-operational states assessed with the standardized M.D. Anderson Dysphagia Inventory (MDADI) and psychosocial distress (PD) questionnaire. Apart from blood loss, subjective symptoms were evaluated 1 and 6 weeks and 6 months after surgery. The differences in indicators between groups were analyzed using Fisher's Least Significant Difference (LSD) test at the 5% significance level. Results. Mean general OS and TORS associated blood loss were 405 and 29 ml, respectively. The mean MDADI score in TORS vs. OS patients one week, six weeks and six months postoperatively was 60.01 vs. 44.93, 91.01 vs. 62.19 and 94.18 vs. 93.56. The mean VAS score in the TORS vs. OS group at the same time intervals were 5.09 vs. 5.56, 2.09 vs. 3.11 and 1.27 vs. 1.33. All differences between TORS and OS were statistically significant with the exception of 6 month values for particular scores. The mean PD score in TORS vs. OS patients in one week, six weeks and 6 months was 26.82 vs. 25.11, 39.95 vs. 29.22 and 44.73 vs. 44.52. Only the six week distinctions were significant. The both methods were comparable in terms of the risk of locoregional tumour recurrence. Conclusions. The study confirmed the assumption of the TORS as a minimally invasive procedure significantly reducing the intraoperative blood loss, pain, swallowing and psychosocial distress as late as 6 weeks postoperatively in patients with early staged carcinomas of the tongue base and supraglottis.

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

“…Steroids have been reported to reduce VAS pain scores and length of stay . Slama et al also investigated TORS for oral cancer and reported an average VAS of 5.1 for week 1, similar to our findings . Thiels et al reported a median prescription of 350 MME and use of 180 MME in TORS tonsillectomies (49% unused) compared to our mean prescription of 368 MME and use of 221 MME (40% unused) .…”

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

“…An initial assessment obtained 33 articles, of which 10 were selected that were potentially relevant after evaluating their abstracts ( 1 , 3 , 6 , 9 , 14 - 19 ). The full texts of those 10 articles were then obtained.…”

Systematic Review of Validated Quality of Life and Swallow Outcomes after Transoral Robotic Surgery

“…29,30 Four studies were cohort studies comparing TORS with other treatment approaches and modalities, including traditional surgical approaches and transoral laser microsurgery (TLM). [31][32][33][34] Population Characteristics…”

“…21 When comparisons were made between those who received TORS and those who received open surgery or CRT, the TORS group had higher QOL scores in several categories at various time points. 22,29,[31][32][33] Several but not all studies reported the lowest QOL scores at 3 months postoperatively and lower QOL scores in several categories among those who received adjuvant therapy after surgery. [17][18][19]21…”