Outcomes of Transoral Robotic Surgery

Abstract

Objective To report long-term, health-related quality of life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS). Study Design Prospective clinical study on functional and HRQOL outcomes in TORS. Setting University tertiary care facility. Subjects Patients who underwent TORS at The Ohio State University Medical Center. Methods All patients undergoing TORS were asked to complete the Head and Neck Cancer Inventory before treatment, and at 3 weeks, 3, 6, and 12 months postoperatively. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected for each patient. Results Sixty four patients who underwent TORS were enrolled with a median age of 56.8years. A total of 113 TORS procedures were performed. Mean follow up time was 16.3 ± 7.49 months (range 6 to 33). Majority of TORS were performed for squamous cell carcinoma (88%). No patients experienced immediate postoperative complications, with all of the patients tolerating an oral diet without any airway compromise on the day of surgery. There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the one year follow up, the HRQOL scores in the aesthetic, social, and overall QOL domains were near baseline. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (p<.05). Forty nine patients (77%) underwent adjuvant radiation therapy (RT), and 61% had chemoradiation (CRT) therapy. Patients who underwent adjuvant XRT or CRT had lower postoperative scores in the eating, social and overall QOL domains, compared to those who did not (p<.05). Conclusion TORS is a safe procedure with good functional and HRQOL outcomes. Patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising future alternative surgical treatment for laryngopharyngeal tumors.

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

“…A single study of radical tonsillectomy reported the placement of gastrostomy tubes intraoperatively in all patients. 15 PEG placement did not differ significantly when stratified by AJCC stage, 12 but one series reported PEG placement exclusively in patients with T3 or T4 tumors and mostly in patients with tongue base primaries. 11 Chronic gastrostomy dependence was reported in 11 of 12 studies, and ranged from 0% to 7% (mean follow-up: 11–32 months), regardless of disease stage.…”

“…Time to oral intake varied by T-stage (Table 2). Oral intake was earlier among 3 series that excluded T4 tumors; 12,13 96% of patients began oral intake on POD #1 after TORS for T1–T2 tumors 12 and mean time to oral intake was 2 days after TORS for T1–T3 OPC tumors. 13 In contrast, only 51% of patients began oral intake on POD #1 after TORS when data were reported for patients of all T-stages (T1–T4).…”

ecancermedicalscience

“…Not all the patients are good candidates for TORS because some of them may present some limiting factors, mostly affecting proper surgical exposure, such as trismus, narrow arched mandible, full dentition, and retrognathia [42]. Access to the tumour may also be influenced by the site and the extension of the tumour, and the equipment employable by the surgeon [16].…”

“…However, the benefits of decreased operative time and decreased length of hospital stay could offset this cost [45]. Operating room setup time and surgical time can be significantly long at the beginning, but all published articles demonstrated a precipitously and significant reduction of those times as the surgeons gained experience with the Da Vinci Surgical System [42] (Table 3). …”

“…At the last follow-up visit, 82 patients had no evidence of disease, one died of the disease, two died of other diseases, and four were alive with disease. The overall two-year recurrence free survival rate was 86.3% [42]. …”