Salvage Transoral Robotic Surgery for Recurrent or Residual Head and Neck Squamous Cell Carcinoma: A Single Institution Experience

Abstract

Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.

Transoral robotic surgery for residual and recurrent oropharyngeal cancers: Exploratory study of surgical innovation using the IDEAL framework for early‐phase surgical studies

“…White et al 25 reported a 2-year recurrence-free survival rate of 74% in a cohort of 64 patients who underwent salvage TORS. In a study of 30 patients who underwent salvage TORS, Dabas et al 26 reported that it was feasible in 100% of 30 patients who were selected for salvage TORS; within this cohort, 13 patients (43.3%) experienced a recurrence, with a median time to recurrence of 3 months (range 1-17 months), which is consistent with the natural history of the disease. It should be noted that this occurred despite the authors achieving a 93% negative margin rate; disease control was achieved in 17 patients (successful salvage rate 56.7%).…”

“…The median survival of the cohort at the time of reporting was 19 months. The comparative data from these 2 articles and our series is summarized in Table . This indicates that the outcomes for the TORS dataset are very comparable to the results of open resections and the transoral laser resections .…”

“…The comparative data from these 2 articles and our series is summarized in Table 2. 25,26 This indicates that the outcomes for the TORS dataset are very comparable to the results of open resections 2 and the transoral laser resections. 27,28 However, the ability to perform intraoperative imaging and flap inset are unique to TORS resections, expanding the patient base for these resections.…”

Head and neck cancers in India

“…53 Practice of head and neck cancers in India has kept pace with recent advances globally. These include surgical procedures like micro vascular free flap reconstruction, 54,55 Laser and Robotic Surgery, 56,57 marginal mandibulectomy, skull base surgery 58,59 as well as nonsurgical organ preservation protocols, advanced RT delivery techniques, 60 and integration of targeted chemotherapy into treatment protocols. 61 A survey to examine the feasibility of applying organ preservation strategies which is the current standard of care, in the general population with the existing resources, was conducted amongst 100 clinicians in head and neck oncology practice.…”

Robot-Assisted Reconstruction in Head and Neck Surgical Oncology: The Evolving Role of the Reconstructive Microsurgeon

“…As experience improves, so larger and more complex resections, including salvage surgery, are becoming possible with TORS [9,11,12]. The natural evolution of this process has meant that reconstructive surgeons are beginning to investigate the role of robot-assisted reconstruction (RAR) and transoral robotic reconstructive surgery (TORRS) [13].…”