Preliminary study of transoral robotic surgery for pharyngeal cancer in Japan

Abstract

Transoral robotic surgery (TORS) with the da Vinci Surgical System has been used for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. While TORS has been approved in many countries, Japan’s FDA has not yet done so. Our hospital started using TORS with the approval of the Ethical Review Board and the Minimum Invasive Surgical Center Committee at Tottori University. No surgical outcomes of TORS for Japanese patients with head and neck cancer have been reported in Japan. This paper deals with the outcomes and feasibility of TORS for Japanese patients with pharyngeal cancer at our institution. TORS was performed for 10 patients with T1, T2, T3 oropharyngeal and hypopharyngeal squamous cell carcinoma between 2013 and 2014. This is a single-institutional study. TORS could be completed for all cases, except one patient that was not candidate, and no intraoperative conversion to an open surgical procedure was required. Five patients underwent neck dissection, two of them concurrent and three staged. Of all patients, positive surgical margins were detected in two. The average blood loss including neck dissection was 21.5 ± 33.4 ml, the operation time was 183 ± 36 min and the console time was 103 ± 22 min. No tracheostomy had been performed either pre- or postoperatively, and there was no difference between preoperative and postoperative swallowing functions. In this single-institutional preliminary study, we demonstrated that TORS is a feasible and safe treatment. A clinical multi-institutional study of TORS for laryngopharyngeal cancer has been approved as an advanced medical system study and is under way. In the near future, it is expected that the efficacy and safety of TORS for laryngopharyngeal cancer will be confirmed as the result of this multiple-institutional clinical study in Japan.

Preoperative predictors of dysphagia after transoral surgery

“…TORS was first introduced by Weinstein et al in 2005 in their case report of supraglottic laryngectomy performed in a canine model [5]. TORS with the da Vinci Surgical System has been used to remove pharyngeal and laryngeal cancers with the objective of improving functional and aesthetic outcomes without worsening survival [6][7][8]. Additional transoral surgery (TOS) techniques have been developed, such as transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngopharyngeal surgery (ELPS).…”

The dawn of robotic surgery in otolaryngology-head and neck surgery

“…TORS was approved by Japan PMDA in 2018 but national healthcare coverage is still not granted. A multi-institutional clinical trial (Kyoto University, Tottori University and Tokyo Medical University) was done to assess the safety and feasibility of TORS for PMDA approval and for national healthcare coverage (56,57). The reasons for the lingering process of TORS approval in Japan may be related to concerns over liability and the potential risks associated with highly advanced robotic systems and may also be related to the cost burdens.…”

Transoral robotic surgery advantages and disadvantages: a narrative review

“…Through TORS, surgeons have been able to visualise areas and successfully inset free flaps in a minimally invasive manner [17]. Although there were complications through the above applications such as a few cases of mild dysphonia, negative final frozen section margins [61] and increased risk of severe short‐term dysphagia and dysphagia‐related complications in retrophangeal lymph nodes (RPLNs) cases [29], high completion rate in comparison with other transoral surgical procedures was achieved [23–25], reserving as much swallowing and speech as possible [10, 57] and there was no need for gastrointestinal tube postoperatively [23–25].…”

“…The last one includes publications for TORS in paediatric patients with head and neck cancer [21, 22] and more rare tumours such as Ewing's sarcoma of the tongue [20] (see Table 1). Pharynx [23–30] : This category includes the publications for TORS in pharynx [23–25], nasopharynx (NP) [26] – located to the upper part of the pharynx –, parapharynx space tumours [27, 28] – located deep within the neck and it is a potential space lateral to the upper pharynx – and retropharynx [29, 30] – which is the posterior part of the pharynx – (see Table 2). Oropharynx [1, 31–52] : This category includes all the publications related to TORS, which refer to oropharyngeal carcinomas and tumours.…”