Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Abstract

IMPORTANCE Treatment of oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and can be associated with significant morbidity. Transoral robotic surgery (TORS) has emerged as a treatment modality for OPSCC, but data comparing outcomes between patients treated with TORS-based therapy and nonsurgical therapy are limited. OBJECTIVE To compare survival and gastrostomy prevalence between patients with OPSCC treated with TORS-based therapy and those treated with nonsurgical therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched-cohort study identified patients with OPSCC treated at the University of Washington and University of Minnesota tertiary care medical centers from January 1, 2005, to December 31, 2013. Each patient treated with TORS-based therapy was matched by stage with as many as 3 patients treated with nonsurgical therapy. Final follow-up was completed on April 1, 2015. MAIN OUTCOMES AND MEASURES Disease-free survival, overall survival, and gastrostomy tube prevalence. RESULTS One hundred twenty-seven patients met the study criteria (113 men [89.0%];14 women [11.0%]; median [interquartile range] age, 57 [52–63] years); 39 patients who underwent TORS were matched to 88 patients who underwent nonsurgical therapy. Compared with the nonsurgical group, more patients had p16-positive tumors in the TORS group (30 of 31 [96.8%] vs 30 of 37 [81.1%] among patients with known p16 status). No statistically significant difference in survival between treatment groups was found in multivariable analysis (disease-free survival hazard ratio, 0.22; 95% CI, 0.04–1.36; P = .10). Patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (13 of 39 [33.3%] vs 74 of 88 [84.1%]) for a univariable relative risk of 0.43 (95% CI, 0.27–0.67; P < .001) and a multivariable relative risk of 0.43 (95% CI, 0.27–0.68; P < .001). Gastrostomy prevalence decreased by time after treatment for both groups (TORS group:3 of 34 [9%] at 3 months to 1 of 33 [3%] at 12 months; nonsurgical group: 37 of 82 [45%] at3 months to 7 of 66 [11%] at 12 months). CONCLUSIONS AND RELEVANCE Patients undergoing TORS for OPSCC have statistically indistinguishable survival but lower gastrostomy prevalence compared with patients undergoing nonsurgical therapy for stage-matched OPSCC. TORS offers promise for improved swallowing function in patients with OPSCC.

Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption

“…TORS patients have been reported to have a shorter length of stay in the hospital and are less likely to rely on gastrostomy and tracheostomy tubes 6 months after surgery than their counterparts undergoing open surgery. Furthermore, based on the Head and Neck Cancer Inventory questionnaire, TORS patients showed no decrease in overall QoL a year after surgery when compared to their own presurgical baseline …”

Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents

“…1 Focused reading: Peer-reviewed journal articles and book chapters were chosen to highlight anatomic considerations, technical aspects of TORS, as well as outcomes and complications of TORS [8, 12, 19-23]. Publications from manufacturers about the surgical robotic system [24] and one of the retractors [25] used in TORS were also included.…”

“…Initial results of patients who underwent TORS showed feasibility and low complication rates, good swallowing function and quality of life, as well as good oncologic outcomes [1-7]. Patients with oropharyngeal cancer who undergo TORS have decreased percutaneous endoscopic gastrostomy prevalence, a proxy for swallowing function, and at least comparable survival in comparison to matched oropharyngeal cancer patients treated with nonsurgical therapy [8]. Another advantage of TORS is the ability to use pathologic staging to guide (either de-intensify or intensify) adjuvant therapy [9, 10].…”

Transoral Robotic Surgery for Oropharyngeal Cancer

“…In an observational study [16] of 74 patients treated with TORS and adjuvant therapy and 46 patients treated with definitive CRT, primary TORS resulted in significantly better saliva-related quality of life than definitive CRT at 1, 6, 12, and 24 months (p < 0.001, p = 0.035, p = 0.005, p = 0.007). Using gastrostomy use as a surrogate marker of poor swallowing, in a retrospective matched cohort study, Sharma et al [17] identified that patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (risk reduction by 57%); over time, gastrostomy prevalence decreased for both groups, with 3% of gastrostomy patients in the TORS group and 11% in the non-surgical group. Similar findings were identified in a systematic review involving 20 case series, including 8 IMRT studies (1,287 patients) and 12 TORS studies (772 patients).…”