Short-term postoperative distress associated with open vs.  transoral robotic surgery (TORS) in patients with T1-T2 carcinomas of the tongue base and supraglottis

Sláma, Karel; Slouka, David; Slípka, J; Fischer, Slavomil

doi:10.5507/bp.2016.015

Cited by 24 publications

(32 citation statements)

References 22 publications

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“…Steroids have been reported to reduce VAS pain scores and length of stay . Slama et al also investigated TORS for oral cancer and reported an average VAS of 5.1 for week 1, similar to our findings . Thiels et al reported a median prescription of 350 MME and use of 180 MME in TORS tonsillectomies (49% unused) compared to our mean prescription of 368 MME and use of 221 MME (40% unused) .…”

Section: Discussionsupporting

confidence: 87%

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Dang

Duffy

et al. 2019

The Laryngoscope

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Objectives In otolaryngology, postoperative pain management lacks evidence‐based guidelines. We designed a prospective, multiphasic study aimed to develop evidence‐based guidelines for postoperative pain management within our institution. In this first phase of our project, we investigated opioid prescription and consumption as well as pain trends for common otolaryngologic procedures. Methods Patients (n = 161) who underwent procedures between July 2018 and February 2019 were surveyed on their postoperative opioid usage and pain from day of discharge to first clinic visit. Opioid prescriptions were converted to standardized units of morphine milligram equivalents (MME). The procedures selected for analysis were parathyroidectomy/thyroidectomy, parotidectomy, sialendoscopy, and transoral robotic surgery resection (TORS). Results In total, 19,748 MME were prescribed: 8,588 MME (43.5%) were used, leaving 11,159 MME (56.5%) unused. TORS average MME used: 221 ± 227; total MME unused: 38%. Sialendoscopy average MME used: 31 ± 46; total MME unused: 67%. Parathyroidectomy/thyroidectomy average MME used: 30 ± 37; total MME unused: 66%. Parotidectomy average MME used: 43 ± 53; total MME unused: 65%. Male gender, smoking (current and former), and psychiatric medication use were positive predictors of opioid consumption in postoperative patients (P < 0.001). Conclusion At our institution, over 50% of prescribed postoperative opioids went unused. This was most pronounced for nonmucosal surgeries. Postoperative pain management should account for this to minimize unnecessary opioid prescriptions. Based on our findings and review of current literature, we are in the process of developing prescribing recommendations to be implemented within our institution. Level of Evidence 2 Laryngoscope, 130:659–665, 2020

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Section: Discussionsupporting

confidence: 87%

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Dang

Duffy

et al. 2019

The Laryngoscope

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“…An initial assessment obtained 33 articles, of which 10 were selected that were potentially relevant after evaluating their abstracts ( 1 , 3 , 6 , 9 , 14 - 19 ). The full texts of those 10 articles were then obtained.…”

Section: Resultsmentioning

confidence: 99%

Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature

Roselló¹,

Albuquerque²,

Roselló-Llabrés³

et al. 2020

Med Oral

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Background TORS has become one of the latest surgical alternatives in the treatment of oropharynx squamous cell carcinomas (OPSCC) and has become increasingly accepted by surgeons as a treatment option. Surgical robots were designed for various purposes, such as allowing remote telesurgery, and eliminating human factors like trembling. The study aimed to compare systematic review of the available literature in order to evaluate the safety and efficacy of Transoral Robotic Surgery (TORS) compared with open surgery. Material and Methods We performed a systematic review of the available literature in order to evaluate the safety and effectiveness of TORS compared with open surgery. We compared TORS and open surgery based on 16 outcomes divided in to 3 groups: intra-operative complications, post-operative complications, and functional and oncologic outcomes. An electronic search of observational studies was carried out using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Oral Health Group Trials Register, and Scielo. Data analysis was carried out in accordance to Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) and the quality of the studies were evaluated using the Newcastle-Ottawa Scale. No language restrictions were imposed. Results From the 4 studies identified (Newcastle-Ottawa Scale mean score 6.5), 371 patients were revised (186 patients were treated with TORS and 185 with conventional surgery). Overall, TORS, when compared with open surgery, appears to have better functional results (less hospital time, decannulation) and fewer intraoperative and post-operative complications. There is no significant difference when assessing the oncological outcomes (positive margins, survival rate) when comparing both techniques. Conclusions TORS has an overall better functional outcome, and less intraoperative and postoperative complications with no difference in positive margins and survival rate when compared with conventional therapy. Key words: Transoral Robotic Surgery, TORS, open surgery, conventional surgery, head and neck cancer, oral cancer.

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“…29,30 Four studies were cohort studies comparing TORS with other treatment approaches and modalities, including traditional surgical approaches and transoral laser microsurgery (TLM). [31][32][33][34] Population Characteristics…”

Section: Resultsmentioning

confidence: 99%

“…21 When comparisons were made between those who received TORS and those who received open surgery or CRT, the TORS group had higher QOL scores in several categories at various time points. 22,29,[31][32][33] Several but not all studies reported the lowest QOL scores at 3 months postoperatively and lower QOL scores in several categories among those who received adjuvant therapy after surgery. [17][18][19]21…”

Section: Quality Of Lifementioning

confidence: 99%

Systematic Review of Validated Quality of Life and Swallow Outcomes after Transoral Robotic Surgery

Castellano

Sharma

2019

Otolaryngol.--head neck surg.

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Objective To systematically review the available evidence on the effects of transoral robotic surgery (TORS) on the posttreatment quality of life (QOL) and swallow function of patients with head and neck cancer. Data Sources PubMed and Ovid electronic databases were searched from inception to July 6, 2016. Specific database functions were applied to maximize the search. Review Methods Articles in the database were reviewed for inclusion by 2 independent reviewers according to predetermined eligibility criteria. The references of relevant articles were then hand-searched to identify additional manuscripts. For included articles, the study characteristics and relevant data were extracted. Results Of 103 articles screened, 20 reporting validated measures of QOL and/or swallow outcomes for 659 patients were eligible for inclusion. Fourteen were observational studies or case series and did not compare the TORS group with another intervention. Two were prospective nonrandomized clinical trials that compared outcomes between TORS and primary chemoradiation. Four were cohort studies comparing TORS with other treatment approaches and modalities, including open surgical approaches and transoral laser microsurgery. Overall, most patients who underwent TORS ± adjuvant therapy reported a return to baseline QOL and swallow function by 6 to 12 months posttreatment. Several studies demonstrated superior QOL and swallowing outcomes when compared with primary chemoradiation or open approaches. Conclusions Available evidence suggests that patients who undergo TORS for head and neck cancer have good QOL and swallowing outcomes after treatment, but outcomes are dependent on baseline function, T stage, and adjuvant treatment status.

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Short-term postoperative distress associated with open vs. transoral robotic surgery (TORS) in patients with T1-T2 carcinomas of the tongue base and supraglottis

Cited by 24 publications

References 22 publications

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature

Systematic Review of Validated Quality of Life and Swallow Outcomes after Transoral Robotic Surgery

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