Transoral robotic surgery versus nonrobotic resection of oropharyngeal squamous cell carcinoma

Chillakuru, Yeshwant; Benito, Daniel A.; Strum, David P.; Mehta, Varun S.; Saini, Prashant; Shim, Timothy; Darwish, Christina; Joshi, Arjun S.; Thakkar, Punam; Goodman, Joseph

doi:10.1002/hed.26724

Cited by 18 publications

(18 citation statements)

References 43 publications

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“…Finally, the rate of pathologic ECE observed among patients treated with TORS was 25%, which is also noteworthy. Although this rate of ECE is relatively high in comparison with SCC of other head and neck subsites, similarly high rates of pathologic ECE have been reported by other national studies of surgically treated OPSCC (23%‐31%) 24,25 . Interestingly, a recent meta‐analysis of HPV‐related OPSCC found that the T stage, the number of nodal metastases, lymphovascular invasion, and perineural invasion were associated with higher rates of disease recurrence but not ECE 26 .…”

Section: Discussionsupporting

confidence: 61%

“…Although this rate of ECE is relatively high in comparison with SCC of other head and neck subsites, similarly high rates of pathologic ECE have been reported by other national studies of surgically treated OPSCC (23%-31%). 24,25 Interestingly, a recent metaanalysis of HPV-related OPSCC found that the T stage, the number of nodal metastases, lymphovascular invasion, and perineural invasion were associated with higher rates of disease recurrence but not ECE. 26 Whether ECE should be considered an indication for the addition of adjuvant systemic therapy in surgically treated HPV-related OPSCC remains an important ongoing area of research.…”

Section: Discussionmentioning

confidence: 99%

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Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers

Oliver

Persky

Wang

et al. 2021

Cancer

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Background Transoral robotic surgery (TORS) was approved by the Food and Drug Administration in 2009 for the treatment of oropharyngeal cancers (oropharyngeal squamous cell carcinoma [OPSCC]). This study investigated the adoption and safety of TORS. Methods All patients who underwent TORS for OPSCC in the National Cancer Data Base from 2010 to 2016 were selected. Trends in the positive margin rate (PMR), 30‐day unplanned readmission, and early postoperative mortality were evaluated. Outcomes after TORS, nonrobotic surgery (NRS), and nonsurgical treatment were compared with matched‐pair survival analyses. Results From 2010 to 2016, among 73,661 patients with OPSCC, 50,643 were treated nonsurgically, 18,024 were treated with NRS, and 4994 were treated with TORS. TORS utilization increased every year from 2010 (n = 363; 4.2%) to 2016 (n = 994; 8.3%). The TORS PMR for base of tongue malignancies decreased significantly over the study period (21.6% in 2010‐2011 vs 15.8% in 2015‐2016; P = .03). The TORS PMR at high‐volume centers (≥10 cases per year; 11.2%) was almost half that of low‐volume centers (<10 cases per year; 19.3%; P < .001). The rates of 30‐day unplanned readmission (4.1%) and 30‐day postoperative mortality (1.0%) after TORS were low and did not vary over time. High‐volume TORS centers had significantly lower rates of 30‐day postoperative mortality than low‐volume centers (0.5% vs 1.5%; P = .006). In matched‐pair analyses controlling for clinicopathologic cofactors, 30‐, 60‐, and 90‐day posttreatment mortality did not vary among patients with OPSCC treated with TORS, NRS, or nonsurgical treatment. Conclusions TORS has become widely adopted and remains safe across the country with a very low risk of severe complications comparable to the risk with NRS. Although safety is excellent nationally, high‐volume TORS centers have superior outcomes with lower rates of positive margins and early postoperative mortality.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers

Oliver

Persky

Wang

et al. 2021

Cancer

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“…25,26 In multiple national studies, TORS has been associated with reduced margin positivity and improved OS in patients with OPC versus other surgical approaches. 15,27 The positive margin rate in this cohort was very favorable at 13.7%. Nguyen et al postulated the survival benefit may be due to the technical advantages of TORS including improved visualization angles, magnified views, increased range of motion, and ability to use en bloc resection techniques.…”

Section: Discussionmentioning

confidence: 72%

“…However, minimally invasive techniques are associated with significantly less morbidity than the traditional approaches and may optimize oncologic outcomes, as well 25,26 . In multiple national studies, TORS has been associated with reduced margin positivity and improved OS in patients with OPC versus other surgical approaches 15,27 . The positive margin rate in this cohort was very favorable at 13.7%.…”

Section: Discussionmentioning

confidence: 79%

Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus‐negative oropharyngeal cancer

2022

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Background: Surgery + adjuvant therapy was shown to have improved overall survival (OS) versus nonsurgical treatment in T1-T2N1-N2b human papillomavirus (HPV)-negative oropharyngeal cancer (OPC). Our objective was to compare OS in transoral robotic surgery (TORS) with neck dissection versus nonsurgical treatment for T1-T2N0 HPV-negative OPC. Methods: Patients with T1-T2N0 HPV-negative OPC were identified in the National Cancer Database. OS was compared between groups: (1) TORS with neck dissection +/À adjuvant therapy, (2) primary radiotherapy (>60 Gy) +/À chemotherapy using Kaplan-Meier and multivariable Cox proportional hazards models. Results: There were 665 (78.4%) patients treated nonsurgically and 183 (21.6%) patients in the TORS group. Adjusting for age, comorbidity score, facility type, tumor subsite, and tumor stage, primary nonsurgical treatment was associated with worse OS (hazard ratio: 1.90, 95% CI: 1.34-2.69). Conclusion:For T1-T2N0 HPV-negative OPC, TORS with neck dissection may be associated with a survival benefit over nonsurgical treatment.

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“…They showed that TORS had a lower rate of tracheotomy during treatment (3.9% vs. 11.4%) and post-treatment gastrostomy tube use (21.9% vs. 34.2%) than non-robotic surgery ( 16 ). Furthermore, a retrospective cohort study using de-identified data from the National Cancer Database from 2010 to 2016 by Chillakuru et al, comparing TORS (N=2288) with non-robotic surgery (N=3167), showed that patients who underwent TORS had better OS rates than those who underwent non-robotic surgery regardless of human papillomavirus status ( 17 ). After TORS using the da Vinci Robotic Surgical System (Intuitive Surgical) was approved by the United States Food and Drug Administration in 2009, TORS has now spread nationwide for the treatment of pharyngeal and laryngeal cancer in the United States.…”

Section: Treatment Outcomes Of Torsmentioning

confidence: 99%

Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan

et al. 2021

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As the laryngopharynx is closely related to swallowing, speech, and phonation, it is necessary to consider not only disease control but also a minimally invasive approach for the treatment of laryngopharyngeal cancer. Transoral surgery has been reported to be a minimally invasive method for treating these diseases. Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan and recently emerged as treatments for patients with early stage pharyngeal and laryngeal cancers. However, securing an appropriate field of view and a narrow operating space during TOVS or ELPS are critical issues to be resolved for these surgeries. The clinical significance and safety of transoral robotic surgery (TORS) using the da Vinci Surgical System have been widely reported to provide surgeons with increased visualization and magnification, resulting in precise surgical margins and rapid functional recovery. In this context, a multi-institutional clinical study was conducted to evaluate the treatment outcomes of TORS for the treatment of laryngopharyngeal cancer in Japan, and the da Vinci Surgical System for oral robot-assisted surgery for these diseases was approved by the Pharmaceutical Affairs Agency in August 2018. This review provides an overview of the therapeutic effects of TOVS, ELPS, and TORS, with a particular focus on these therapeutic results in Japan.

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Transoral robotic surgery versus nonrobotic resection of oropharyngeal squamous cell carcinoma

Cited by 18 publications

References 43 publications

Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers

Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers

Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus‐negative oropharyngeal cancer

Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan

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