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

Abstract

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.

Oncologic outcomes of human papillomavirus–associated oropharynx carcinoma treated with surgery alone: A 12‐institution study of 344 patients

“…The most common presentations for HPV+OPSCC are the clinical N2a/N2b stages (AJCC 7th), which together represent 30% to 51% of all patients with HPV+OPSCC 21,44‐46 . Sparing patients definitive and adjuvant radiation and chemotherapy‐related sequelae and side effects would have potential swallowing, salivary, taste, dental, psychosocial, otologic, neurologic, nephrological, hematologic, and financial benefits in the first few years after treatment 23,25‐28,47 . Avoidance of radiation could also eliminate the radiation‐related toxicities that can occur many years later, such as delayed swallowing dysfunction, neck and throat fibrosis, dental decay, osteoradionecrosis of the mandible, hypothyroidism, and radiation‐induced cancers, all of which are less often reported in studies 7,48‐51 .…”

“…Studies have shown that primary surgical treatment with guideline‐based adjuvant therapy has recurrence and survival rates comparable to those of primary definitive chemoradiation 10,21‐24 . Furthermore, some studies have demonstrated better QOL in patients undergoing primary surgery for OPSCC even with aRT in comparison with definitive nonsurgical protocols 22,25‐28 . Select patients who undergo definitive surgery could, therefore, benefit from further de‐intensified aRT or no adjuvant treatment.…”

Robotic surgery of the anterior skull base

“…TORS has been shown to be safe and at least as effective as traditional approaches and has reduced morbidity and quality of life in head and neck surgery . TORS has shown preservation of laryngopharyngeal function without compromising oncologic outcomes and has reduced the need for adjuvant therapy using an “inside‐out” approach . In a more recent study, TORS has also been shown to have a lower rate of positive margins when compared to non‐robotic surgery, particularly in high‐volume centers …”

Human Papillomavirus-Associated Head and Neck Cancer

“…TORS has been shown to have equivalent outcomes as CRT, and it may allow for improved long-term outcomes from CRT de-escalation. 28 Currently, there is literature to support improved quality of life in patients treated with TORS, 29,30 although the subject at the moment is controversial. Recently the ORATOR trial, a phase 2 randomized study demonstrated that patients undergoing TORS actually had worse swallowing-related quality of life scores 1 year after treatment, compared with the radiotherapy-treated group.…”