Surgeon Experience and Complications with Transoral Robotic Surgery (TORS)

Chia, Stanley H.; Gross, Neil D.; Richmon, Jeremy D.

doi:10.1177/0194599813503446

Cited by 145 publications

(172 citation statements)

References 28 publications

(100 reference statements)

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“…In cases of OPSCCA, 1-year overall survival rates are reported at higher than 90%, and 2-year survival rates are reported at 80% to 90%, with locoregional recurrence rates of 3% to 6%, following TORS surgery, and the surgery has low complication rates in experienced surgeons. 12,13,15,47,[54][55][56] A recent study by Kaczmar et al 57 highlights that HPV-positive oropharyngeal carcinomas very rarely have locoregional recurrence, and the authors could not find any predictive model using the common prognostic factors. Human papillomavirus status has a significant effect on prognosis, because 2-year overall and disease-free survival rates may rates be up to 20% better in the HPV-positive tumor patient.…”

Section: Transoral Robotic Surgerymentioning

confidence: 99%

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Helman¹,

Schwedhelm²,

Kadakia³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context The incidence of oropharyngeal squamous cell carcinoma has increased during the past decade and is related primarily to the human papillomavirus. This change in etiology, from tobacco and alcohol to human papillomavirus, has resulted in improved survival for the disease. In the United States, open resection had largely been replaced by concurrent chemotherapy and/or radiotherapy by the early 2000s. The advent of transoral surgery has led to an increase in surgery as the primary treatment for both early- and advanced-stage oropharyngeal squamous cell carcinoma because it has potential advantages over open surgery and nonsurgical modalities. Objective To provide an overview of transoral robotic surgery for oropharyngeal squamous cell carcinoma and contrast it with other surgical and nonsurgical modalities. Data Sources Articles from 2000 to 2014 were accessioned on PubMed and reviewed for utility by the primary authors. Conclusions Transoral surgery has become more commonly used as a minimally invasive approach to treat oropharyngeal tumors. Other strategies, including radiation, chemotherapy with radiation, and open surgery, are still important treatment approaches. The treatment options for an individual patient rely on multiple factors, including the tumor location and size, features of the tumor, and patient comorbidities. The continued study of these techniques is important to match the patient with the most appropriate treatment.

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Section: Transoral Robotic Surgerymentioning

confidence: 99%

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Helman¹,

Schwedhelm²,

Kadakia³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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“…The cumulative incidence of complications following TORS varies with surgical experience, but is generally near 10%, with postoperative hemorrhage accounting for approximately 3% of these adverse events [20]. Other studies have documented postoperative bleeding in up to 7.5% of patients following TORS for a variety of indications [21].…”

Section: Discussionmentioning

confidence: 99%

“…TORS is currently being used in the management of early-stage tumors, more advanced malignancies, tumor recurrences, deep neck space infections, tumors of unknown primary site, and comparatively benign conditions such as obstructive sleep apnea [1,[15][16][17][18]. The incidence of postoperative complications seen with TORS is generally low and has the potential to be further reduced by increased experience with the technique and an appreciation of risk factors for the most common issues [5,[19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

et al. 2017

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Background: Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods: A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results: The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.

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“…La complication postopératoire la plus fréquente retrouvée dans environ 3 à 5 % des cas est l'hémorragie secondaire pouvant survenir dans les 15 jours qui suivent la chirurgie [15]. Ces hémorragies sont la cause la plus fréquente des décès postopératoires qui restent cependant inférieurs à 1 %.…”

Section: Chirurgie De La Tumeur Primitiveunclassified

“…Ces hémorragies sont la cause la plus fréquente des décès postopératoires qui restent cependant inférieurs à 1 %. Elles ne sont pas liées spécifiquement à l'utilisation du robot et peuvent aussi bien se voir après chirurgie au laser [15,16]. Elles s'expliquent en effet par le fait que dans la chirurgie transorale le lit d'exérèse est généralement laissé en cicatrisation dirigée sans couverture par un lambeau.…”

Section: Chirurgie De La Tumeur Primitiveunclassified

Head and neck oncologic surgery today and tomorrow

Bozec

Céruse

2015

Oncologie

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Reçu le 25 février 2015 ; accepté le 28 avril 2015 © Lavoisier SAS 2015Résumé La chirurgie garde une place centrale dans le traitement des cancers de la face et du cou. Elle s'intègre dans le cadre d'une prise en charge multidisciplinaire globale et personnalisée du patient. Tout en respectant les règles générales de la chirurgie oncologique, elle devient de plus en plus ciblée sur les structures anatomiques réellement atteintes et donc conservatrice des tissus sains environnants. Les progrès des voies d'abord chirurgical, le développement de la chirurgie endoscopique et transorale (laser, chirurgie assistée par robot), de même que les avancées de la chirurgie reconstructive ont permis de diminuer la morbidité chirurgicale et d'améliorer les résultats fonctionnels postopératoires.Mots clés Cancers de la face et du cou · Chirurgie oncologique · Chirurgie assistée par robot · Prise en charge personnalisée Abstract Surgery plays a central role in the multimodal and personalized therapeutic management of head and neck cancers. While complying with general rules of oncologic surgery, head and neck surgery has become more conservative. Head and neck surgery removes more selectively the anatomical structures that are invaded by the tumor and spares the normal healthy tissues. Progress of surgical approaches, endoscopic and transoral (laser, robot-assisted surgery) surgery development, as well as advances in reconstructive surgery have led to reduction in surgical morbidity and improvement in postoperative surgical outcomes.

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Surgeon Experience and Complications with Transoral Robotic Surgery (TORS)

Abstract: TORS is associated with a low major complication rate, early initiation of oral intake, and a low rate of long-term PEG dependency. Postoperative hemorrhage was the most common cause of hospital readmission and postoperative mortality.

Cited by 145 publications

References 28 publications

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

Head and neck oncologic surgery today and tomorrow

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