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

Abstract

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

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

“…3 Li et al reported a PMR of 16.5% in T1/T2 patients, which was lower than both nonrobotic surgery and transoral laser microsurgery (28.4% and 21.4%, respectively). 15 Zevallos et al demonstrated a PMR of 16.8% for TORS patients of all T classifications as compared to 28.3% for other transoral, nonrobotic approaches, although this difference was not significant in their multivariable model. 21 A study of low-classification (T1/T2) OPSCC in the NCDB by Cracchiolo et al yielded an overall PMR of 24% for all primary surgical patients.…”

Robotic surgery of the anterior skull base

“…TORS has been shown to be safe and at least as effective as traditional approaches and has reduced morbidity and quality of life in head and neck surgery . TORS has shown preservation of laryngopharyngeal function without compromising oncologic outcomes and has reduced the need for adjuvant therapy using an “inside‐out” approach . In a more recent study, TORS has also been shown to have a lower rate of positive margins when compared to non‐robotic surgery, particularly in high‐volume centers …”

Is robotic surgery an option for early T‐stage laryngeal cancer? Early nationwide results

“…Both variables were used to isolate surgical modalities. As in previous studies, laser surgery was identified via NCDB surgery of the primary site codes 14 (local destruction with laser) and 25 (local laser excision) and open surgery via the surgical approach variable . To eliminate overlap for laser patients, only those with laparoscopic listed under surgical approach were included.…”