The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Cancer: A Review of the Literature

Abstract

Background. Transoral robotic surgery (TORS) is an emerging treatment option for the treatment of head and neck malignancies, particularly for oropharyngeal squamous cell carcinoma (OPSCC). Preliminary studies have demonstrated excellent oncologic and functional outcomes that have led to a resurgence of interest in the primary surgical management of OPSCC. The aim of the present study was to review the evidence base supporting the use of TORS in OPSCC. Methods. Studies evaluating the application of TORS in the treatment of head and neck squamous cell carcinoma (HNSCC), and more specifically OPSCC, were identified for review. Further searches were made of reference lists for complete evaluation of minimally invasive surgery (MIS) in treating OPSCC. Results. Seventeen results relating to the application of TORS in treatment of OPSCC were identified. Further results relating to the role of transoral laser microsurgery (TLM) in OPSCC were included for review. Feasibility, oncologic, and functional data is summarized and discussed. Discussion. Management strategies for patients with OPSCC continue to evolve. Minimally invasive surgical techniques including TORS and TLM offer impressive functional and oncologic outcomes particularly for patients with early T-classification and low-volume regional metastatic disease. Potential exists for treatment deintensification, particularly in patients who are HPV positive.

Transoral Robotic Surgery in Oropharyngeal Carcinoma

“…Previous studies have reported a setup time of 15 to 19 minutes, with an operative time of 39 to 84 minutes, depending on the exact procedure and experience level of the team. 12,54 Complications include hemorrhage (2.4%), fistula formation (2.5%), wound infection (2.3%), and pneumonia (0%-7%). 12,15,55 Only a few patients require the long-term use of PEG tubes (0%-9%) or tracheotomies (3%), and the remainder are decannulated within a few days of surgery.…”

“…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.…”

De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

“…eHNS is performed with carbon dioxide laser microsurgery or robotic surgical system and has been associated with a resurgence of primary surgical treatment for T1-T2 OPC [16]. Early reports have demonstrated that eHNS is associated with a lower complication rate and faster post-operative recovery [17,18]. Moreover, oncologic outcomes from eHNS appear to be promising.…”

“…Moreover, oncologic outcomes from eHNS appear to be promising. A 2012 meta-analysis of over 500 OPSCC patients from 17 retrospective eHNS studies showed 1-year OS of over 90% and 2-year survival between 80 and 90% [18]. Most patients in this meta-analysis with standard indications for adjuvant treatment received adjuvant radiation or chemoradiation.…”

Preoperative predictors of difficult hypopharyngeal exposure by retractor for transoral robotic surgery

“…Many studies have reported the feasibility of transoral robotic surgery (TORS) for the treatment of laryngeal, hypopharyngeal, and supraglottic cancer with excellent results in terms of oncologic radicality and functional preservation [2,3]. Therefore, recently, transoral robotic surgery has been gaining popularity as a new treatment modality for laryngopharyngeal cancer, and it is being performed widely [4].…”