The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Cancer: A Review of the Literature

Dowthwaite, Samuel; Franklin, Jason; Palma, David A.; Fung, Kevin; Nichols, Anthony C.

doi:10.5402/2012/945162

Cited by 85 publications

(95 citation statements)

References 62 publications

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“…Previous studies have reported a setup time of 15 to 19 minutes, with an operative time of 39 to 84 minutes, depending on the exact procedure and experience level of the team. 12,54 Complications include hemorrhage (2.4%), fistula formation (2.5%), wound infection (2.3%), and pneumonia (0%-7%). 12,15,55 Only a few patients require the long-term use of PEG tubes (0%-9%) or tracheotomies (3%), and the remainder are decannulated within a few days of surgery.…”

Section: Transoral Robotic Surgerymentioning

confidence: 99%

“…In cases of OPSCCA, 1-year overall survival rates are reported at higher than 90%, and 2-year survival rates are reported at 80% to 90%, with locoregional recurrence rates of 3% to 6%, following TORS surgery, and the surgery has low complication rates in experienced surgeons. 12,13,15,47,[54][55][56] A recent study by Kaczmar et al 57 highlights that HPV-positive oropharyngeal carcinomas very rarely have locoregional recurrence, and the authors could not find any predictive model using the common prognostic factors. Human papillomavirus status has a significant effect on prognosis, because 2-year overall and disease-free survival rates may rates be up to 20% better in the HPV-positive tumor patient.…”

Section: Transoral Robotic Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Helman¹,

Schwedhelm²,

Kadakia³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context The incidence of oropharyngeal squamous cell carcinoma has increased during the past decade and is related primarily to the human papillomavirus. This change in etiology, from tobacco and alcohol to human papillomavirus, has resulted in improved survival for the disease. In the United States, open resection had largely been replaced by concurrent chemotherapy and/or radiotherapy by the early 2000s. The advent of transoral surgery has led to an increase in surgery as the primary treatment for both early- and advanced-stage oropharyngeal squamous cell carcinoma because it has potential advantages over open surgery and nonsurgical modalities. Objective To provide an overview of transoral robotic surgery for oropharyngeal squamous cell carcinoma and contrast it with other surgical and nonsurgical modalities. Data Sources Articles from 2000 to 2014 were accessioned on PubMed and reviewed for utility by the primary authors. Conclusions Transoral surgery has become more commonly used as a minimally invasive approach to treat oropharyngeal tumors. Other strategies, including radiation, chemotherapy with radiation, and open surgery, are still important treatment approaches. The treatment options for an individual patient rely on multiple factors, including the tumor location and size, features of the tumor, and patient comorbidities. The continued study of these techniques is important to match the patient with the most appropriate treatment.

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Section: Transoral Robotic Surgerymentioning

confidence: 99%

Section: Transoral Robotic Surgerymentioning

confidence: 99%

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Helman¹,

Schwedhelm²,

Kadakia³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…eHNS is performed with carbon dioxide laser microsurgery or robotic surgical system and has been associated with a resurgence of primary surgical treatment for T1-T2 OPC [16]. Early reports have demonstrated that eHNS is associated with a lower complication rate and faster post-operative recovery [17,18]. Moreover, oncologic outcomes from eHNS appear to be promising.…”

Section: Oropharynx Carcinoma Surgerymentioning

confidence: 99%

“…Moreover, oncologic outcomes from eHNS appear to be promising. A 2012 meta-analysis of over 500 OPSCC patients from 17 retrospective eHNS studies showed 1-year OS of over 90% and 2-year survival between 80 and 90% [18]. Most patients in this meta-analysis with standard indications for adjuvant treatment received adjuvant radiation or chemoradiation.…”

Section: Oropharynx Carcinoma Surgerymentioning

confidence: 99%

De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

Holsinger

Husain

2016

Cancers Head Neck

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Current adjuvant treatment guidelines for oropharyngeal squamous cell carcinoma treated with primary surgery are based on studies that predate the human papillomavirus (HPV) era. HPV-associated oropharynx carcinoma (HPV-OPC) has a much more favorable prognosis compared to HPV-unassociated cancer and is increasingly considered to be a distinct disease entity due to its unique etiology, presentation, and behavior. Currently, there is significant interest in adjuvant treatment de-intensification of HPV-OPC patients in order to reduce treatment-related toxicity while maintaining excellent clinical outcomes. Here, we review the evidence and rationale underlying the ongoing prospective trials of adjuvant treatment de-intensification for HPV-OPC patients.

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“…Many studies have reported the feasibility of transoral robotic surgery (TORS) for the treatment of laryngeal, hypopharyngeal, and supraglottic cancer with excellent results in terms of oncologic radicality and functional preservation [2,3]. Therefore, recently, transoral robotic surgery has been gaining popularity as a new treatment modality for laryngopharyngeal cancer, and it is being performed widely [4].…”

Section: Introductionmentioning

confidence: 99%

Preoperative predictors of difficult hypopharyngeal exposure by retractor for transoral robotic surgery

et al. 2018

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Introduction Transoral endoscopic surgeries provide excellent oncologic outcomes while preserving speech and swallowing ability. However, feasibility has been a major concern about transoral surgery. Therefore, ensuring visualization of the surgical field and sufficient working space is required. The aim of this study was to evaluate the parameters in the preoperative assessment that affect hypopharyngeal exposure. Methods Before transoral surgery, parameters regarding the patient's neck and face such as modified Mallampati index, thyroid-mental distance (TMD), and ability to fully open the mouth were evaluated. Cephalometry and cervical spine radiography were performed preoperatively to evaluate the size of the mandible bone, mouth opening, and cervical spine extension. Mandibular bone parameters such as intergonion distance, mental-gonion distance, articulare-gonion distance, and aperture angle were measured. According to hypopharyngeal exposure using FKWO retractor, patients were divided into difficult hypopharyngeal exposure group (DHE) and non-difficult hypopharyngeal exposure group (non-DHE). Parameters were enrolled to evaluate the relationship between these parameters and DHE status. Results This study included 51 patients, 37 in the non-DHE group and 14 in the DHE group. On radiographic evaluation, there was a significant difference in the degree of cervical lordosis between non-DHE and DHE patients. A significantly higher proportion of DHE patients had a history of radiotherapy compared with non-DHE patients. Conclusion Patients with limited cervical extension and a history of previous radiotherapy might have difficult hypopharyngeal exposure during transoral surgery. This is the first report to suggest a classification system for hypopharyngeal exposure during transoral surgery.

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The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Cancer: A Review of the Literature

Cited by 85 publications

References 62 publications

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Transoral Robotic Surgery in Oropharyngeal Carcinoma

De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

Preoperative predictors of difficult hypopharyngeal exposure by retractor for transoral robotic surgery

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