Spondylodiscitis after transoral robotic surgery: Retrospective 7-case series from the GETTEC group

Carpentier, C.; Bobillier, C.; Blanchard, D.; Lallemant, Benjamin; Garrel, R.; Gorphe, Philippe; Mastronicola, Romina; Morinière, S.

doi:10.1016/j.anorl.2019.03.004

Cited by 12 publications

(13 citation statements)

References 18 publications

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“…Patient 2 died of cervical vertebral osteomyelitis 1 month after adjuvant radiation therapy. In a cohort comprising 1084 robotic procedures performed at 13 centers, this rare complication was the cause of death in 0.2% of patients, all with posterior pharyngeal wall cancers, with 4 receiving salvage surgery. A 1-cm mucosal margin in a cancer approaching the posterior tonsil pillar can expose a substantial amount of cervical spine.…”

supporting

confidence: 80%

Caution Regarding Assessment of Toxic Effects and Survival in Treatment De-escalation With Radiotherapy vs Transoral Surgery for Human Papillomavirus–Associated Oropharyngeal Cancer

2022

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supporting

confidence: 80%

Caution Regarding Assessment of Toxic Effects and Survival in Treatment De-escalation With Radiotherapy vs Transoral Surgery for Human Papillomavirus–Associated Oropharyngeal Cancer

2022

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“…One patient died of an oropharyngeal hemorrhage in hospital on day 4 after undergoing resection of a well-lateralized base of tongue cancer despite having a tracheostomy in place and having the ipsilateral external carotid artery ligated intraoperatively. A second patient died of cervical vertebral osteomyelitis that occurred on the ipsilateral side of the spine to the resection approximately 1 month after completing treatment with adjuvant RT after undergoing TORS for a tonsil cancer (110 days postsurgery), a complication previously reported after TORS (associated with a 43% mortality rate), also known as spondylodiscitis . Overall rates of related grade 2 or greater toxic effects were similar between arms (occurring in 20 patients [67%] in the RT arm and 22 [71%] in the TOS and ND arm).…”

Section: Resultsmentioning

confidence: 88%

Assessment of Toxic Effects and Survival in Treatment Deescalation With Radiotherapy vs Transoral Surgery for HPV-Associated Oropharyngeal Squamous Cell Carcinoma

et al. 2022

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IMPORTANCEThe optimal approach for treatment deescalation in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCCs) is unknown.OBJECTIVE To assess a primary radiotherapy (RT) approach vs a primary transoral surgical (TOS) approach in treatment deescalation for HPV-related OPSCC. DESIGN, SETTING, AND PARTICIPANTSThis international, multicenter, open-label parallel-group phase 2 randomized clinical trial was conducted at 9 tertiary academic cancer centers in Canada and Australia and enrolled patients with T1-T2N0-2 p16-positive OPSCC between February 13, 2018, and November 17, 2020. Patients had up to 3 years of follow-up.INTERVENTIONS Primary RT (consisting of 60 Gy of RT with concurrent weekly cisplatin in node-positive patients) vs TOS and neck dissection (ND) (with adjuvant reduced-dose RT depending on pathologic findings). MAIN OUTCOMES AND MEASURESThe primary end point was overall survival (OS) compared with a historical control. Secondary end points included progression-free survival (PFS), quality of life, and toxic effects. RESULTSOverall, 61 patients were randomized (30 [49.2%] in the RT arm and 31 [50.8%] in the TOS and ND arm; median [IQR] age, 61.9 [57.2-67.9] years; 8 women [13.6%] and 51 men [86.4%]; 31 [50.8%] never smoked). The trial began in February 2018, and accrual was halted in November 2020 because of excessive toxic effects in the TOS and ND arm. Median follow-up was 17 months (IQR, 15-20 months). For the OS end point, there were 3 death events, all in the TOS and ND arm, including the 2 treatment-related deaths (0.7 and 4.3 months after randomization, respectively) and 1 of myocardial infarction at 8.5 months. There were 4 events for the PFS end point, also all in the TOS and ND arm, which included the 3 mortality events and 1 local recurrence. Thus, the OS and PFS data remained immature. Grade 2 to 5 toxic effects occurred in 20 patients (67%) in the RT arm and 22 (71%) in the TOS and ND arm. Mean (SD) MD Anderson Dysphagia Inventory scores at 1 year were similar between arms (85.7 [15.6] and 84.7 [14.5], respectively). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, TOS was associated with an unacceptable risk of grade 5 toxic effects, but patients in both trial arms achieved good swallowing outcomes at 1 year. Long-term follow-up is required to assess OS and PFS outcomes.

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“…Additional complications, yet less frequent, include neck hematoma in 0.4% and pharyngo-cutaneous fistula in 2.5% of cases [ 38 , 87 , 88 ]. Spondylodiscitis is a severe complication to keep in mind after TORS for SCCs of the posterior pharyngeal wall, occurring after a mean interval of over 2 months postoperatively [ 89 ]. Complications related to robot docking and instrument collision include lip, dental, and corneal injury.…”

Section: Postoperative Course and Complicationsmentioning

confidence: 99%

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

Mella

Chabrillac

Dupret‐Bories

et al. 2023

JCM

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Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.

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Spondylodiscitis after transoral robotic surgery: Retrospective 7-case series from the GETTEC group

Cited by 12 publications

References 18 publications

Caution Regarding Assessment of Toxic Effects and Survival in Treatment De-escalation With Radiotherapy vs Transoral Surgery for Human Papillomavirus–Associated Oropharyngeal Cancer

Caution Regarding Assessment of Toxic Effects and Survival in Treatment De-escalation With Radiotherapy vs Transoral Surgery for Human Papillomavirus–Associated Oropharyngeal Cancer

Assessment of Toxic Effects and Survival in Treatment Deescalation With Radiotherapy vs Transoral Surgery for HPV-Associated Oropharyngeal Squamous Cell Carcinoma

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

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