Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation

Dhanireddy, Bhaswanth; Burnett, Nicolas P.; Sanampudi, Sreeja; Wooten, C.E.; Slezak, Jon; Shelton, Brent J.; Shelton, Lauren; Shearer, Andrew; Arnold, Susanne M.; Kudrimoti, Mahesh; Gal, Thomas J.

doi:10.1016/j.amjoto.2019.06.001

Cited by 31 publications

(28 citation statements)

References 22 publications

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“…Dhanireddy et al compared TOS (n = 65) and non-TOS (n = 54) in a predominantly HPV(+) cohort (46%-80%). 19 This study did not demonstrate any statistically significant difference in terms of OS and DFS. Being a retrospective review, the non-TOS arm had a greater number of patients with a larger nodal burden (p < 0.0001).…”

Section: Discussioncontrasting

confidence: 50%

“…This apparent difference with respect to the type of treatment could be attributed to the higher number of HPV‐associated cancers (87% vs. 46%) in the surgical arm and increased prevalence of advanced tumors in the nonsurgical arm (63% vs. 10%). Dhanireddy et al compared TOS ( n = 65) and non‐TOS ( n = 54) in a predominantly HPV(+) cohort (46%–80%) 19 . This study did not demonstrate any statistically significant difference in terms of OS and DFS.…”

Section: Discussionmentioning

confidence: 68%

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A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

et al. 2021

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Background With the termination of RTOG 1221, there remains a lacuna regarding the optimal treatment for human papillomavirus (HPV)‐negative oropharyngeal squamous cell carcinoma (OPSCC). Methods Matched pair analysis with propensity score matching (PSM) between Arm I (transoral surgery [TOS] + risk‐stratified adjuvant treatment) and Arm II (nonsurgical treatment − radiation/chemoradiation) in HPV(−) OPSCC. Results Unmatched comparison of Arm I (n = 57) and Arm II (n = 89) indicated significantly better overall survival (OS) and disease‐free survival (DFS) for Arm I. PSM by matched pairs (n = 48, 24 each arm) indicated 5‐year OS at 80% and 72.1%, respectively, for Arm I and II (p > 0.05) and corresponding DFS at 65.3% and 33.4% (p > 0.05). Subgroup analysis did not demonstrate statistical difference in outcomes in stage II and III, but stage IV tumors had significantly better outcomes in Arm I than Arm II (4‐year OS: 100% vs. 21%, p = 0.04; DFS: 75% vs. 14.3%, p = 0.04). Conclusions TOS +/− adjuvant was found to have oncological outcomes at par with nonsurgical modalities in stage I–III OPSCC, whereas a distinct survival advantage was noted in case of stage IV tumors.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 68%

A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

et al. 2021

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“…Omorogieva et al 28 and Callahan et al 29 calculated a conservative estimated cost of $31 832 per year for gastrostomy tube use. Wide variation within published literature regarding feeding tube duration 9,29 likely reflects differences in institutional protocols with regards to nutritional support. Opinion as to the impact of long‐term feeding tube use has on swallowing is inconclusive (Shaw et al 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous tools and methods are used to assess communication and swallowing function, making it difficult to compare outcomes for patients across the various International Classification of Functioning, Disability and Health (ICF) domains of body structure, activity, and participation. Feeding tube duration, as evaluated by Dhanireddy et al, 9 is an important measure but neglects the participant's speech, quality of life, or swallowing ability. The M. D. Anderson Dysphagia Inventory (MDADI) 10 is a validated patient‐reported outcome (PRO) measure that examines swallowing‐related quality of life, 8,11 but may not correlate with instrumentally assessed swallow pathophysiology 12 .…”

Section: Introductionmentioning

confidence: 99%

Swallowing and communication outcomes following primary transoral robotic surgery

Charters

Milross

et al. 2021

Head & Neck

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Background Heterogeneity within studies examining transoral robotic surgery (TORS) for oropharyngeal cancer (OPC) has made it challenging to make clear conclusions on functional outcomes. Infrequent use of instrumental swallow examinations compounds uncertainty surrounding the proposed functional advantage to TORS. Methods A prospective cohort of 49 patients underwent speech and swallowing assessment 12 months following treatment for OPC. Patients were assessed using fibreoptic endoscopic evaluation of swallowing (FEES), clinician‐ and patient‐reported outcomes. Participants were matched according to tumor site, T category, and age. Speech and swallowing outcomes were compared for those receiving TORS versus chemoradiation. Results When adjuvant radiotherapy to the primary site could be avoided, TORS demonstrated an advantage for feeding tube duration, secretion severity, penetration/aspiration, M. D. Anderson Dysphagia Inventory (MDADI), and airway protection. Conclusion This explorative study suggests that a treatment philosophy of selecting patients for TORS where adjuvant therapy can be omitted or confined to the neck warrants further evaluation.

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“…Transoral robotic surgery (TORS) is a valuable treatment for oropharyngeal squamous cell carcinoma, avoiding the need for a jaw split and tracheostomy [ 1 ]. Robot-assisted thoracic surgery (RATS) is popular for major lung resections and mediastinal mass excisions, reducing the need for thoracotomy [ 2 ] and time to adjuvant therapies [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Single-session, dual-site robotic surgery for synchronous primary malignancies of the oropharynx and thorax

Kelly

Oikonomou

Tornari

et al. 2020

Journal of Surgical Case Reports

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Single-session, dual-site robotic surgery for synchronous malignancies is not widely reported. To our knowledge, there are no previous reports of transoral robotic surgery (TORS) and robot-assisted thoracic surgery (RATS) in a single sitting. A 49-year-old male presented with a neck lump. Biopsies and imaging proved synchronous primaries of the tonsil and lung. The morbidity of primary dual-site chemoradiotherapy, or open surgery, presented a management challenge. We therefore opted for sequential robotic resections, in a single sitting. The patient was discharged on Day 6 post-operatively and was able to start radiotherapy less than 3 weeks post-operatively. Undertaking TORS and RATS in a single sitting is feasible and safe. This approach allowed fast-tracking of adjuvant oncological therapy, arguably conveying the greatest chance of cure. We detail the rationale and utility of this novel approach and describe the surgical and anaesthetic challenges of two teams undertaking sequential robotic procedures in a single sitting.

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Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation

Cited by 31 publications

References 22 publications

A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

Swallowing and communication outcomes following primary transoral robotic surgery

Single-session, dual-site robotic surgery for synchronous primary malignancies of the oropharynx and thorax

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