Current indications and patient selection for transoral robotic
surgery in head and neck cancer: a brief review

Niewinski, Patryk

doi:10.5114/wo.2022.118240

Cited by 5 publications

(12 citation statements)

References 33 publications

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“…Like for any type of surgery, medical comorbidities need to be assessed in order to predict possible complications and correct reversible states prior to surgery. Congestive heart failure, pulmonary disease, connective tissue diseases, morbid obesity, poorly controlled diabetes, immunosuppression, and malnutrition are considered as relative contraindications for surgery [ 4 , 13 ]. In addition to determining the patient’s operability, these comorbidities also weigh on the decision to perform a prophylactic tracheostomy [ 14 , 15 ].…”

Section: Preoperative Considerations and Eligibility Criteriamentioning

confidence: 99%

“…Laryngeal cancer: Tumors resectable with TORS should not invade the thyroid or cricoid cartilages, pre-epiglottic space, paraglottic space, posterior commissure, base-of-tongue musculature, or more than 20 mm of base-of-tongue mucosa [ 4 , 20 ].…”

Section: Preoperative Considerations and Eligibility Criteriamentioning

confidence: 99%

“…Supraglottic laryngectomy: After the first use of TORS for supra-glottic laryngectomy in a canine model in 2005, this technique has spread widely and has now become a routine therapeutic option for supraglottic cancer [ 4 ]. However, supraglottic cancers are rarely diagnosed at an early stage, and surgical exposure is the main limiting factor for their excision by TORS.…”

Section: Tors Applications In Hncmentioning

confidence: 99%

“…Despite their adequate oncological outcomes, traditional therapeutic options for HNC place a burden on functional results. Thus, it is by improving the postoperative course and functional outcomes that minimally invasive surgery has gained recognition in the field of HNC [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Robotic surgery using the Da Vinci ® surgical system gained popularity in the early 2000s in the fields of urology and gynecology thanks to its magnified three-dimensional vision, absence of surgeon tremor, and higher precision. This technology offers better surgical comfort in remote-access areas due to the presence of wristed instruments with seven degrees of freedom [ 4 ]. In 2007, the concept of transoral robotic surgery (TORS) was introduced by Weinstein et al [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

Mella

Chabrillac

Dupret‐Bories

et al. 2023

JCM

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Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.

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Section: Preoperative Considerations and Eligibility Criteriamentioning

confidence: 99%

Section: Preoperative Considerations and Eligibility Criteriamentioning

confidence: 99%

Section: Tors Applications In Hncmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

Mella

Chabrillac

Dupret‐Bories

et al. 2023

JCM

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Autonomous Robotic Systems in Otolaryngology-Head and Neck Surgery

Sriram,

Creighton,

Galaiya

2024

Otolaryngologic Clinics of North America

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Outcomes for Potentially Resectable Patients Undergoing Primary Chemoradiation Treatment for T1 – T2 HPV Negative Oropharyngeal Squamous Cell Carcinoma

Laxague

Fnais

Son

et al. 2023

Preprint

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Background A previous study in HPV-positive patients have shown that transoral surgical resectability (TOS) is a strong prognostic factor for patients with T1-2 disease undergoing radiotherapy (RT), but it is unclear whether this holds for HPV-negative patients, in whom the biology is different and outcomes are worse. We aimed to compare outcomes of potential TOS-candidates vs. non-TOS candidates, among patients who underwent RT/CRT for early T-stage human papillomavirus-negative (HPV-negative) OPSCC. Methods For patients treated with RT/CRT for early-stage HPV-negative OPSCC between 2014 and 2021, pretreatment imaging was reviewed by four head-and-neck surgeons, blinded to outcomes, to assess primary-site suitability for TOS, and extracapsular extension (ECE) was assessed by a head-and-neck neuroradiologist. We compared outcomes based on surgical resectability relating to: 1) the primary site tumor alone, and 2) the primary site plus the absence/presence of ECE (overall assessment). Kaplan-Meier curves for overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) were compared using the log-rank test, with Cox regression for multivariable modeling. Results Seventy patients were included in the analysis. The mean age was 63.1 years and the majority of the patients were male 39/70 (55.7%). The primary site was TOS-favorable in 46/70 (66%). Based on the overall assessment (including the primary site and positive lymph nodes), 41/70 (58.6%) were TOS-favorable. The 3-year OS, DSS and PFS for primary site TOS-favorable vs. unfavorable were OS: 76.9% vs. 37.4%; DSS: 78.1% vs 46.2%, PFS: 69.9% vs 41.3%, (log-rank test = 0.01, 0.03, 0.04; respectively). Additionally, patients with an overall assessment of TOS favorability demonstrated better survival outcomes compared with TOS-unfavorable patients (OS: 77.3% vs. 46.2%; DSS: 78.2% vs. 56.5%, PFS: 72.3% vs. 42.1%, log-rank test = 0.01, 0.04, 0.01; respectively). Conclusion Patients with TOS-favorable HPV-negative early T-stage OPSCC have superior survival outcomes than TOS-unfavorable patients. This critical confounder needs to be considered when comparing primary surgical and primary radiation clinical trials and retrospective studies.

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Current indications and patient selection for transoral robotic surgery in head and neck cancer: a brief review

Cited by 5 publications

References 33 publications

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

Autonomous Robotic Systems in Otolaryngology-Head and Neck Surgery

Outcomes for Potentially Resectable Patients Undergoing Primary Chemoradiation Treatment for T1 – T2 HPV Negative Oropharyngeal Squamous Cell Carcinoma

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