Transoral Robotic Surgery for Oropharyngeal Cancer

Dziegielewski, Peter T.; Teknos, Theodoros N.; Durmuş, Kasım; Old, Matthew; Agrawal, Amit; Kakarala, Kiran; Marcinow, Anna M.; Özer, Enver

doi:10.1001/jamaoto.2013.2747

Cited by 196 publications

(70 citation statements)

References 49 publications

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“…Only 28.2% required trimodality therapy (TORS followed by adjuvant CRT), which is less than the percentage of patients requiring trimodality therapy in some prior studies (43%−62%). 7,8,23,24 The relatively low frequency of trimodality therapy in our study population may partially explain the lower gastrostomy prevalence in the TORS group compared with the nonsurgical group, because the use of CRT is known to have adverse effects on swallowing function. 20 Although fewer patients undergoing TORS in our study received trimodality therapy compared with some prior studies, their survival was not inferior to that of patients undergoing RT/CRT in this matched analysis.…”

Section: Discussionmentioning

confidence: 93%

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

Sharma

Patel

Baik

et al. 2016

JAMA Otolaryngol Head Neck Surg

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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.

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Section: Discussionmentioning

confidence: 93%

“…The TORS system offers ready access to the oropharynx without external incisions for precise resections with minimal disruption of adjacent structures. 3 Studies have shown high survival rates, 4–6 low complication rates, 7 good swallowing function, 4–6,8 and excellent quality-of-life (QOL) 8 outcomes after TORS.…”

mentioning

confidence: 99%

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

Sharma

Patel

Baik

et al. 2016

JAMA Otolaryngol Head Neck Surg

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“…[27] Disparity between the clinical AJCC/UICC TNM stage and survival in HPV-positive OPSCC[14,17] speaks to the need for a new staging paradigm. Moreover, there is significant discordance between clinical/radiological and pathologic nodal staging for head and neck carcinoma in general[28] and specifically for HPV-positive OPSCC.…”

Section: Introductionmentioning

confidence: 99%

“…Prognostic pathologic parameters have been identified in surgical HPV-positive OPSCC cohorts. 13–18, 23,27 To test these prognosticators, this study assembled a p16-positive OPSCC database from five centers. The study objectives were to assess:…”

Section: Introductionmentioning

confidence: 99%

Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx

et al. 2016

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Objective The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. Methods Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for a) the AJCC/UICC pathologic staging, b) newly published clinical staging for non-surgically managed HPV-positive OPSCC and c), a novel, pathology-based, “HPVpath” staging system that combines features of the primary tumor and nodal metastases. Results A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (<4 versus ≥5) yielded three groups, stages I (pT1-T2, ≤ 4 nodes), II (pT1-T2, ≥ 5 nodes; pT3-T4, ≤ 4 nodes), and III (pT3-T4, ≥ 5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. Conclusions Three loco-regional “HPVpath” stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to guide prognosis and adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.

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“…In 2009, the FDA approved the use of TORS to treat benign and malignant tumors of the head and neck. 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].…”

Section: Introductionmentioning

confidence: 99%

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

White

Sharma²

2018

ORL

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Purpose of the Study: (1) To develop a multifaceted didactic and hands-on curriculum to prepare otolaryngology residents to perform transoral robotic surgery (TORS) and safely transition to the operating room. (2) To assess the effectiveness of the TORS curriculum. Procedures: Learning objectives were developed and a curriculum was formulated utilizing five unique modalities: focused didactic reading, online training modules, backpack console simulations, videos of TORS cases, and hands-on cadaveric dissections with the robotic surgical system in a simulated operating room. The trainees completed a nine-item self-assessment of their skill level using a Likert scale. Results: Five senior otolaryngology residents completed the TORS curriculum. Before and after the cadaveric dissections, there was improvement in each of the nine items assessed. Composite scores were calculated and there was significant improvement from predissection (15.2 ± 2.2) to postdissection (31.4 ± 1.9) (p = 0.002). Conclusions: The current study demonstrates the feasibility of implementing a multifaceted TORS curriculum which incorporates robotic cadaveric dissection for otolaryngology residents. Residents demonstrate marked improvement in skills with the TORS curriculum. A TORS curriculum which includes robotic cadaveric dissection can improve surgical skills and serve as a key component of residency TORS education.

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Transoral Robotic Surgery for Oropharyngeal Cancer

Cited by 196 publications

References 49 publications

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

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

Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx

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

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