Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis

Virgilio, Armando De; Costantino, Andrea; Mercante, Giuseppe; Pellini, Raul; Ferreli, Fabio; Malvezzi, Luca; Colombo, Giovanni; Cugini, Giovanni; Petruzzi, Gerardo; Spriano, Giuseppe

doi:10.1007/s00405-020-06224-z

Cited by 41 publications

(24 citation statements)

References 74 publications

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“…OPSCC oncologic surgery has undergone an intense transformation over the past 30 years. Although complete tumor removal with free surgical margins remains the cornerstone of surgical treatment, surgical techniques have evolved from radical nonconservative open surgery to functional organ preservation surgery [45][46][47]. Since the beginning of the 2000s, the classical transmandibular approach has been replaced, in most cases, by a double transoral and transcervical approach, preventing the complications related to mandibular osteotomy [45].…”

Section: Evolution Of Surgical Techniquesmentioning

confidence: 99%

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

Bozec

Culié

Poissonnet

et al. 2021

Cancers

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Since there is no published randomized study comparing surgical and non-surgical therapeutic strategies in patients with oropharyngeal squamous cell carcinoma (OPSCC), the therapeutic management of these patients remains highly controversial. While human papillomavirus (HPV)-positive and HPV-negative OPSCC are now recognized as two distinct diseases with different epidemiological, biological, and clinical characteristics, the impact of HPV status on the management of OPSCC patients is still unclear. In this review, we analyze the current therapeutic options in patients with OPSCC, highlighting the most recent advances in surgical and non-surgical therapies, and we discuss the impact of HPV status on the therapeutic strategy.

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Section: Evolution Of Surgical Techniquesmentioning

confidence: 99%

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

Bozec

Culié

Poissonnet

et al. 2021

Cancers

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“…This is thought to be due to the advantages of assistance by a robotic device with a 3D ‘in-field’ endoscope and EndoWrist ® articulated instruments compared to ‘out-of-the-field’ conventional surgery [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. In oropharyngeal carcinomas, TORS with or without adjuvant has been used mainly for the surgical management of limited-size primary tumors on tongue bases or on tonsils with variable rates of early-stage and advanced-stage disease depending on the metastatic lymph nodes, resulting in very good functional and oncological outcomes [ 14 ]. In recent years, as a result of technological improvements and the increase in surgical experience with TORS, a number of teams have extended the size and complexity of resections [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Indications and Clinical Outcomes of Transoral Robotic Surgery and Free Flap Reconstruction

Gorphe

Temam

Moya‐Plana

et al. 2021

Cancers

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We reviewed the indications, peroperative feasibility, and postoperative clinical outcomes of our first 50 consecutive patients who underwent free flap reconstruction after TORS for complex pharyngeal defects at our institution. We analyzed indications according to previous radiotherapy, the size of the resection, and the transoral exposure of critical structures. We reviewed surgical data, postoperative complications, and functional outcomes comprising tracheostomy and alimentation management. Indications were upfront surgery (34%), a second primary surgery after radiotherapy (28%), or salvage surgery after chemoradiotherapy failure (38%). Localizations were the tongue base (44%), tonsillar fossa (28%), pharyngeal wall (22%), and soft palate (6%). T-classifications were T1 (6%), T2 (52%), T3 (20%), and T4 (22%). The mean length of the surgery was 574 min. Two patients were intraoperatively converted to a conventional approach at the beginning of the learning curve. In conclusion, TORS and free flap reconstruction in complex situations were associated with low rates of postoperative complications and satisfactory functional outcomes. They were, however, associated with a renewed learning curve.

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“…Transoral robotic surgery (TORS) is now well-integrated in the armamentarium of the head and neck surgeon for the treatment of malignant neoplasms of the head and neck, [1][2][3][4][5][6][7][8][9][10][11] as well as in the management of unknown primary tumors presenting with cervical lymph node metastasis 12,13 and of benign neoplasms and diseases such as obstructive sleep apnea syndrome (OSAS). [14][15][16][17] Within the upper aerodigestive tract, the oropharynx is the area most frequently treated with TORS.…”

Section: Introductionmentioning

confidence: 99%

“…18 Nonsurgical options, represented by definitive (chemo)radiotherapy (C)RT, avoid the morbidity of surgery, but have been associated with an increasing toxicity burden, including dysphagia, xerostomia, and mucositis. [19][20][21] TORS achieves the same or better oncological outcomes with superb functional results compared to open surgery, 7,[22][23][24][25][26][27][28][29][30] with a low rate of complications 31,32 and less radiationrelated toxicity in adequately selected patients. 33,34 Exposure is paramount for the success of TORS both for performing surgery safely and for achieving a marginfree resection in case of malignancies.…”

Section: Introductionmentioning

confidence: 99%

Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore

et al. 2021

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Background Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a “Pharyngoscore” to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. Methods Three‐hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh–Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. Results Sixty‐five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. Conclusions The Pharyngoscore is a promising tool for calculating DOE probability before TORS.

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Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis

Cited by 41 publications

References 74 publications

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

Indications and Clinical Outcomes of Transoral Robotic Surgery and Free Flap Reconstruction

Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore

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