Transoral Robotic Surgery for Oropharyngeal Cancer

Paleri, Vinidh; Fox, Hannah; Winter, Stuart C

doi:10.1159/000489466

Cited by 11 publications

(13 citation statements)

References 43 publications

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Section: Ta B L Ementioning

confidence: 99%

“…35 Differences in the surgical technique-described in five papers-of BOT mucosectomy might influence results in terms of identification rates. 11,13,17,19,21 Paleri et al 36 recommend to use a midline incision for two separate BOT specimens for proper orientation and reduction of specimen trauma (see Figure 2A,B which show a left sided BOT mucosectomy). Pathology laboratory protocols differ widely, potentially leading to large differences in identification rate in different centres.…”

Section: Ta B L E 1 Diagnostic Pre-tors Workup Data In Cupmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable?

Weert

Rijken

Plantone

et al. 2020

Clinical Otolaryngology

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Background Transoral robotic surgery (TORS) is increasingly used in head and neck surgery and in carcinoma of unknown primary (CUP) origin specifically. Due to the rising incidence of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC), there is a rationale for finding ways to de‐escalate treatment strategies. This review aims to test the hypothesis that TORS is a meaningful adjunct in the diagnostic (and therapeutic) pathway in CUP in head and neck. Methods A structured search of the literature was performed with the search terms ‘TORS’ and ‘Carcinoma of Unknown Primary’. Results Two hundred and seventy four cases of CUP in which TORS was used were identified for further analysis. Workup for CUP was comparable in all series with regard to physical examination, fine and/or gross needle examination of cervical nodes, fibre optic endoscopy, imaging and robot assisted mucosectomy of the base of tongue (BOT). Identification rate of the primary tumour was 72% on average (range 17%‐ 90%), and 55%‐ 96% were HPV positive. Clear margins were achieved in 60% (range 0%‐85%) of resected occult tumours. Complication rate of TORS BOT mucosectomy was low with mainly grade I‐III sequelae according to Clavien–Dindo. Conclusions Transoral robotic surgery seems to be a useful and safe adjunct in the diagnostic and therapeutic pathway in case of CUP in an era of increasing incidence of HPV‐positive OPSCC.

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Section: Ta B L Ementioning

confidence: 99%

Section: Ta B L E 1 Diagnostic Pre-tors Workup Data In Cupmentioning

confidence: 99%

A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable?

Weert

Rijken

Plantone

et al. 2020

Clinical Otolaryngology

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“…6) is to achieve en bloc resection of the tonsil, the constrictor bed on which it sits, and a cuff of tongue base and soft palate to ensure histologically negative margins. 68 Postoperatively, the tonsil defect is allowed to heal by secondary intention, and complete mucosalization normally occurs within 6 weeks. 68 Early-stage tumors (T1 -less than or equal to 2 cm; T2greater than 2 cm but less than or equal to 4 cm) confined to the tonsillar fossa (Fig.…”

Section: What the Surgeon Wants To Knowmentioning

confidence: 99%

“…68 Postoperatively, the tonsil defect is allowed to heal by secondary intention, and complete mucosalization normally occurs within 6 weeks. 68 Early-stage tumors (T1 -less than or equal to 2 cm; T2greater than 2 cm but less than or equal to 4 cm) confined to the tonsillar fossa (Fig. 7) are very good candidates for TORS, 20,61 though larger tumors may also be successfully removed with TORS when exophytic.…”

Section: What the Surgeon Wants To Knowmentioning

confidence: 99%

Patient Selection for Transoral Robotic Surgery (TORS) in Oropharyngeal Squamous Cell Carcinoma

Bunch

Patwa

Hughes

et al. 2021

Topics in Magnetic Resonance Imaging

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Transoral robotic surgery (TORS) is an excellent treatment strategy for well-selected patients with oropharyngeal squamous cell carcinoma. Potential benefits of TORS are greatest among patients for whom surgical resection will reduce or eliminate the need for adjuvant therapy. Proper patient selection largely depends on imaging, which is used to determine tumor resectability, to inform expected morbidity and functional outcome, to assess the potential need for adjuvant therapy, to evaluate for vascular or other anatomic contraindications, and to gauge adequacy of transoral access to the tumor. This article provides the radiologist with a practical and accessible approach to interpreting preoperative imaging among patients with oropharyngeal cancer, emphasizing what the surgeon wants to know to inform the determination of whether the patient is a TORS candidate and why this information is important. By accurately reporting this information, the radiologist facilitates the multidisciplinary care team's selection of a treatment regimen optimized for the circumstances of the individual patient.

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“…In head and neck surgery minimally-invasive techniques have recently been introduced to reduce access-related morbidity and their associated functional deficits. Such novel approaches are mostly used to access cancers in the oropharynx [ 1 , 2 ]. Trans-oral approaches such as trans-oral laser microsurgery (TLM) and trans-oral robotic surgery (TORS) have provided improved visualization for tumors previously amenable only to transmandibular or other ‘open’ surgical approaches [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of life and health-related utility after trans-oral surgery for head and neck cancers

Parimbelli

Simon²,

Soldati³

et al. 2021

Health Qual Life Outcomes

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Purpose The purpose of this study was to assess utility coefficients of health states following two minimally invasive surgical approaches for head and neck cancer, namely trans-oral robotic surgery and trans-oral laser microsurgery. Those utility coefficients will be later exploited in an economic evaluation study comparing the two approaches. Methods The above cited economic evaluation will be done from the Swiss healthcare system perspective and, as such, Swiss healthcare professionals were interviewed to elicit utility coefficients. Health states, ranging from remission to palliative care, were described using clinical vignettes. A computerized tool (UceWeb) implementing standard gamble and rating scale methods was used. Results Utility coefficients for 18 different health states were elicited with the two methods from 47 individuals, for a total of 1692 values. Elicited values varied from 0.980 to 0.213. Comparison with values elicited in previous studies show the need for population-specific elicitation, mainly for the worst health states. Conclusion Herein we report health utility coefficients for the Swiss population for health states following minimally invasive trans-oral surgery. This study provides utility values that can be used not only for a specific cost-utility analysis, but also for future studies involving the same health states.

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Transoral Robotic Surgery for Oropharyngeal Cancer

Cited by 11 publications

References 43 publications

A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable?

A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable?

Patient Selection for Transoral Robotic Surgery (TORS) in Oropharyngeal Squamous Cell Carcinoma

Quality of life and health-related utility after trans-oral surgery for head and neck cancers

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