Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis

Biron, Vincent L.; O’Connell, Daniel A.; Barber, Brittany; Clark, Jessica M.; Andrews, Colin; Jeffery, Caroline C.; Côté, David; Harris, Jeffrey R.; Seikaly, Hadi

doi:10.1186/s40463-017-0196-0

Cited by 44 publications

(59 citation statements)

References 51 publications

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“…Some cases may require lateral pharyngotomy approach or lip-splitting anterior mandibulotomy for mandibular swing approach. Combined approaches such as transoral robotic surgery and lateral pharyngotomy with radial forearm free flap reconstruction may avoid the need for lip-splitting approach 54 . Treatment for advanced disease might produce the need for temporary tracheostomy and gas- Figure 5 Cranio-facial CT scan and contrast enhanced MRI scan of the patient.…”

Section: Oropharyngeal (Tonsillar) Cancermentioning

confidence: 99%

Difficulties in the surgical management of head and neck cancer patient

Sarafoleanu

Vuzitas

Manea

2017

Romanian Journal of Rhinology

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Malignancies of the upper aerodigestive tract are high morbidity bearing and life-threatening diseases, which require thorough care from diagnostic suspicion and confirmation to surgical and/or oncologic treatment and rehabilitation. Difficulties in managing head and neck cancers arise from delays in diagnosis and treatment caused by either patient-related factors or healthcare system-related factors. Tumor origin and stage determine whether surgical excision is feasible, the approach required for safe excision, the extent of functional and aesthetic sacrifice required to attain oncologic safety and the need for reconstructive surgery. A thorough and systematic preoperative risk versus benefits assessment to select potential surgical candidates and give realistic outcomes is important from both a medical and a legal point of view. Because tumors in the head and neck region frequently involve more than one system and sensory organ, potential loss of function from either the disease course, surgical or nonsurgical treatment should be taken into account form a quality of life perspective. Effective management of head and neck cancer patients requires the cooperation and combined effort of a multidisciplinary team of surgeons, physicians and other workers over a long period of time which, in the absence of a specialised head and neck cancer centre and guidelines, can lead to increased morbidity and mortality, and patient dissatisfaction.

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Section: Oropharyngeal (Tonsillar) Cancermentioning

confidence: 99%

Difficulties in the surgical management of head and neck cancer patient

Sarafoleanu

Vuzitas

Manea

2017

Romanian Journal of Rhinology

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“…Kucur et al reported that among 113 OPC patients treated with TORS, six (5%) developed communications that were closed by submandibular gland or adjacent muscular pedicle flaps (28). For larger communications, a free flap may also be deployed robotically for closure (29).…”

Section: Clinical Applications Of Torsmentioning

confidence: 99%

The dawn of robotic surgery in otolaryngology-head and neck surgery

Nakayama

Holsinger

Chevalier

et al. 2019

Japanese Journal of Clinical Oncology

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Transoral robotic surgery (TORS) utilizing the da Vinci robotic system has opened a new era for minimally-invasive surgery (MIS) in Otolaryngology-Head and Neck Surgery. Awareness of the historical steps in developing robotic surgery (RS) and understanding its current application within our field can help open our imaginations to future of the surgical robotics. We compiled a historical perspective on the evolution of surgical robotics, the road to the da Vinci surgical system, and conducted a review of TORS regarding clinical applications and limitations, prospective clinical trials and current status in Japan. We also provided commentary on the future of surgical robotics within our field. Surgical robotics grew out of the pursuit of telerobotics and the advances in robotics for non-medical applications. Today in our field, cancers and diseases of oropharynx and supraglottis are the most common indications for RS. It has proved capable of preserving the laryngopharyngeal function without compromising oncologic outcomes, and reducing the intensity of adjuvant therapy. TORS has become a standard modality for MIS, and will continue to evolve in the future. As robotic surgical systems evolve with improved capabilities in visual augmentation, spatial navigation, miniaturization, force-feedback and cost-effectiveness, we will see further advances in the current indications, and an expansion of indications. By promoting borderless international collaborations that put 'patients first', the bright future of surgical robotics will synergistically expand to the limits of our imaginations.

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“…The treatment of OPSCC with a primary TORS approach offers a number of advantages. TORS provides excellent access and visibility to for oropharyngeal resection while preserving neuromuscular structures important for swallowing (4,21). Despite the use of conformal techniques, xerostomia and dysphagia remain common morbidities with significant impacts on quality of life (11,27).…”

Section: Discussionmentioning

confidence: 99%

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

Sommerfeld¹,

Jeffery²,

Jm³

et al. 2019

Preprint

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Background As the incidence of HPV/p16-positve oropharyngeal squamous cell carcinoma (OPSCC) continues to rise, a large population of survivors with treatment related morbidity is emerging. Transoral robotic surgery (TORS) is an excellent surgical option for p16-positive OPSCC but data comparing both survival and swallowing outcomes of this treatment versus radiotherapy/chemoradiotherapy (RT/CRT) remains limited. Methods Data was prospectively collected (05/2014 - 02/2019) in a tertiary care referral center from OPSCC patients treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT. Surgical and non-surgical treatment groups were case-matched for smoking status, T-stage, and N-stage based on AJCC 8th edition staging. Patients who were treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT for OPSCC were included. Overall survival, recurrence free survival, aspiration free survival and gastrostomy tube outcomes were compared using univariate and multivariate statistical analyses. Results A total of 82 patients treated with TORS were case-matched with 61 patients who received RT/CRT. TORS patients demonstrated a significantly (p=0.02) higher overall survival (OS) at 3 years (OS=93.2%) compared to RT/CRT patients (OS=78.9%). No statistically significant difference was seen in recurrence free survival when comparing the two groups. TORS patients demonstrated an aspiration free survival (AFS) of 64.7% compared to 26.1% in RT/CRT patients (p=0.02 Log-Rank, 0.018 Breslow). TORS patients also had significantly (p < 0.01) lower gastrostomy tube placement (13.4%) compared to RT/CRT (22.9%) at any point during treatment. Conclusion Patients undergoing treatment by TORS may have comparable survival and improved swallowing outcomes when compared to those undergoing RT/CRT for HPV-OPSCC.

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Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis

Cited by 44 publications

References 51 publications

Difficulties in the surgical management of head and neck cancer patient

Difficulties in the surgical management of head and neck cancer patient

The dawn of robotic surgery in otolaryngology-head and neck surgery

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

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