Transoral robotic surgery for oropharyngeal carcinoma: Surgical margins and oncologic outcomes

Moore, Eric J.; Abel, Kathryn M. Van; Price, Daniel L.; Lohse, Christine M.; Olsen, Kerry D.; Jackson, Ryan; Martin, Eliot J.

doi:10.1002/hed.25055

Cited by 97 publications

(91 citation statements)

References 26 publications

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“…Pooled data from three clinical trials in a study by Weinstein et al yielded a PMR of 3.8% for OP tumors of all classifications, and a retrospective review of 11 academic institutions revealed a rate of 9.9% . Two single‐institution studies, by Moore et al and Persky et al, reported rates of 2% and 10%, respectively, for T1 and T2 tumors . These rates are lower than the PMRs of academic facilities in this study, even when limited to low‐classification tumors (13.9%).…”

Section: Discussioncontrasting

confidence: 56%

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

et al. 2019

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Background Purpose of the study is to assess nationwide margin performance in oropharynx transoral robotic surgery (TORS). Methods Retrospective review of the National Cancer Database. Results Two thousand six hundred sixty‐one patients were included. The national positive margin rate (PMR) was 16.9%. High‐volume facilities had a lower PMR than low‐volume facilities (12.7% vs 21.9%; P < .001). Patients with disease of the tonsil had a lower PMR (15.7%) than base‐of‐the‐tongue (18.2%; P = .14). PMR increased with T classification (T1 = 13.0%, T2 = 17.1%, T3 = 28.2%, T4a = 45.9%, T4b = 58.3%; P < .001). On multivariable regression, factors associated with margin status included only lymph‐vascular invasion (1.63[1.13‐2.36]; P = .01), high volume (0.57[0.36‐0.92]; P = .005), and T classification (as compared to T1, T2: 1.50[1.03‐2.18], T3: 3.11[1.77‐5.46], T4a: 7.03[2.95‐16.75], T4b: 6.72[1.26‐35.93]; P < .001). Conclusions National PMR is 16.9%, substantially higher than reported in high‐volume TORS centers. There is a linear association between positive margins and T classification, with T3 and T4 PMRs exceeding 28%. High‐volume facilities are half as likely to yield positive margins compared to low‐volume facilities. There was no association between human papilloma virus status, tumor subsite, or academic facility status and positive margins.

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Section: Discussioncontrasting

confidence: 56%

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

et al. 2019

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“…We found that patients 70 years or older have similar 3‐year disease‐specific oncologic outcomes (DSS, 94.3%; DFS, 79.3%) compared to published series analyzing younger cohorts . As expected, OS (81.5%) was lower than the 83%‐90% typically reported for HPV‐associated OPSCC, secondary to 21.3% dying of unrelated causes . Our analysis of these data demonstrated that elderly adults with HPV‐associated OPSCC could be subcategorized into three groups, allowing us to describe a clinically relevant decrement in 3‐year OS from 100% to 54% with rising age, ACE‐27 comorbidity score, and cT stage.…”

Section: Discussionsupporting

confidence: 70%

Multi‐institutional analysis of outcomes following transoral surgery for HPV‐positive oropharyngeal squamous cell carcinoma in elderly patients

et al. 2019

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Background The incidence of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC) is rising, even in elderly patients. The outcomes of transoral surgery (TOS) in this population are not entirely known. Methods A retrospective review was performed at two institutions from October 2003 to September 2016 on patients 70 years or older with HPV‐related OPSCC treated with TOS. Results A total of 75 patients were included with a mean age of 74 years (70‐87 years). At a median follow‐up of 35.7 months, 3‐year overall survival was 81.5% and disease‐specific survival was 94.3%. Advanced cT stage (odds ratio, 2.74; 95% confidence interval, 1.13‐6.64) negatively impacted OS. Conjunctive consolidation was performed to create a staging system with patients older than 80 years, severe comorbidity, and cT3‐4 having worse survival. Conclusions Elderly patients with HPV‐related OPSCC treated with TOS have excellent survival and therefore should not be excluded from such therapy based on age alone.

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“…Lörincz et al examined outcomes of 50 patients who underwent TORS and reported 2‐year disease‐free and recurrence‐free survival rates at 88% and 80%, respectively . Similarly, Moore et al, in a recent large case series of 314 TORS patients, found a 3‐year overall survival rate of 91% . The large survival may be attributed to their ability to achieve negative margins in 98% of their cases.…”

Section: Introductionmentioning

confidence: 99%

“…The large survival may be attributed to their ability to achieve negative margins in 98% of their cases. In fact, they found that repeated attempts to secure negative margins were independently associated with death . Understanding whether TORS helps facilitate the achievement of negative margins is important in understanding its clinical impact and future role in OPSCC management.…”

Section: Introductionmentioning

confidence: 99%

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

Torabi

Park

et al. 2018

The Laryngoscope

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Objectives To compare long‐term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM). Study Design A retrospective analysis of the National Cancer Database (2010–2014). Methods Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi‐square tests; Kaplan‐Meier log‐rank test; and Cox multivariate, logistic regression, and multinomial regression modeling. Results We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001). TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303). Conclusion The advantages of TORS for early‐stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy. Level of Evidence NALaryngoscope, 129:1844–1855, 2019

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Transoral robotic surgery for oropharyngeal carcinoma: Surgical margins and oncologic outcomes

Abstract: The need to take ≥2 margins to achieve resection portends an increased risk of locoregional recurrence and death due to disease in oropharyngeal SCC.

Cited by 97 publications

References 26 publications

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

Multi‐institutional analysis of outcomes following transoral surgery for HPV‐positive oropharyngeal squamous cell carcinoma in elderly patients

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

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