Clinical outcomes of transoral robotic-assisted surgery for the management of head and neck cancer

Abstract

Background: Transoral robotic surgery (TORS) has existed for nearly a decade as a treatment option for cancers of the upper aerodigestive tract. A number of Phase II clinical trials, mostly single-arm, are under way systematically examining outcomes of TORS, but the majority of the current literature is retrospective in nature. Objective: The objective of this work was to review the functional and oncologic outcomes of TORS in the treatment of head and neck squamous cell carcinoma broken down by subsite. Methods: A comprehensive search was performed using the MEDLINE database and keywords ("transoral robotic surgery" OR "TORS"). Articles specifically related to our objectives were included in our review. Results: Twenty-six studies describing the functional and oncologic outcomes of TORS were reviewed, with 15 focusing on oropharyngeal cancers and the remainder on laryngeal and unknown primary lesions. TORS was associated with decreased need for free flap reconstruction, hospital stay, postoperative complications, and tracheostomy or gastrostomy tube dependence than open surgery, with at least comparable oncologic outcomes. In comparison with chemoradiation, TORS oropharyngectomy had similar subjective swallowing outcomes, comparable oncologic outcomes, and decreased gastrostomy tube dependence. Patient reported speech and overall health outcomes following TORS oropharyngectomy were equivocal. For patients with unknown primary lesions, the addition of TORS lingual and palatine tonsillectomy significantly increased the rate of identification of the primary site to greater than 70%. Conclusion: Although TORS is a promising treatment option for head and neck squamous cell carcinoma, further prospective trials are needed to more systematically assess outcomes and compare them with other treatment modalities, particularly chemoradiation therapy.