Transoral Robotic Surgery in the Nordic Countries: Current Status and Perspectives

Mäkitie, Antti; Keski-Säntti, Harri; Markkanen‐Leppänen, Mari; Bäck, Leif; Koivunen, Petri; Ekberg, Thomas; Sandström, Karl; Laurell, Göran; Beckerath, Mathias von; Nilsson, Jens; Wahlberg, Peter; Greiff, Lennart; Spaak, Lena Norberg; Kjærgaard, Thomas; Godballe, Christian; Rikardsen, Oddveig G; Channir, Hani Ibrahim; Rubek, Niclas; Buchwald, Christian von

doi:10.3389/fonc.2018.00289

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…The high costs of currently-available surgical robots has led some authors argue that the best approach is to centralize the use of TORS in high-volume treatment centers (53) based on studies showing that such centers obtain better outcomes with lower costs than low-volume centers (54–58). A recent study (59) concluded that high surgical volumes are needed to maintain expertise and quality assurance. That same study concluded that TORS is currently underutilized due to the associated expenses (59), particularly in countries with limited resources such as Estonia, Latvia, and Lithuania where TORS is currently unavailable.…”

Section: Methodsmentioning

confidence: 99%

“…A recent study (59) concluded that high surgical volumes are needed to maintain expertise and quality assurance. That same study concluded that TORS is currently underutilized due to the associated expenses (59), particularly in countries with limited resources such as Estonia, Latvia, and Lithuania where TORS is currently unavailable. Although cost is currently an important barrier to the wider uptake of robotic surgery, the impending commercialization of new, smaller, more flexible surgical robots is likely to decrease costs, and expand current indications for TORS (11).…”

Section: Methodsmentioning

confidence: 99%

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Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Golusiński

2019

Front. Oncol.

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In recent years, interest in functional organ preservation surgery (FOPS) in the treatment of head and neck cancer has increased dramatically as clinicians seek to minimize the adverse effects of treatment while maximizing survival and quality of life. In this context, the use of transoral robotic surgery (TORS) is becoming increasingly common. TORS is a relatively new and rapidly-evolving technique, with a growing range of treatment indications. A wide range of novel, flexible surgical robots are now in development and their commercialization is expected to significantly expand the current indications for TORS. In the present review, we discuss the current and future role of this organ-preserving modality as the central element in the multimodal treatment of head and neck cancer.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Golusiński

2019

Front. Oncol.

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“…T2 N1 M0 tumors (with a single <3 cm lymph node metastasis) may be suitable for chemoradiation, but concomitant chemoradiation is considered to be only a 2B (namely, not strongly supported by evidence) category of choice [41]. The surgical approach that should be chosen is the trans oral robotic surgery (TORS) which in clinical trials is able to guarantee the same efficacy at a price of a significantly minor morbidity [42,43].…”

Section: Hpv-related Tumors: Implications In Clinical Practicementioning

confidence: 99%

Management of HPV-Related Squamous Cell Carcinoma of the Head and Neck: Pitfalls and Caveat

Perri

Longo

Caponigro

et al. 2020

Cancers

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Head and neck squamous cell carcinomas (HNSCCs) are a very heterogeneous group of malignancies arising from the upper aerodigestive tract. They show different clinical behaviors depending on their origin site and genetics. Several data support the existence of at least two genetically different types of HNSCC, one virus-related and the other alcohol and/or tobacco and oral trauma-related, which show both clinical and biological opposite features. In fact, human papillomavirus (HPV)-related HNSCCs, which are mainly located in the oropharynx, are characterized by better prognosis and response to therapies when compared to HPV-negative HNSCCs. Interestingly, virus-related HNSCC has shown a better response to conservative (nonsurgical) treatments and immunotherapy, opening questions about the possibility to perform a pretherapy assessment which could totally guide the treatment strategy. In this review, we summarize molecular differences and similarities between HPV-positive and HPV-negative HNSCC, highlighting their impact on clinical behavior and on therapeutic strategies.Cancers 2020, 12, 975 2 of 14 papilloma virus (HPV)-related tumors [1][2][3]. Several lines of evidence support the existence of at least two genetically different types of HNSCC, one virus-related and the other alcohol and/or tobacco and oral trauma-related, characterized by both clinical and biological opposite features [3,4]. Unlike HPV-negative HNSCC, HPV-positive HNSCC often occurs in younger patients with minimal or no tobacco exposure [5,6]. HPV-positive HNSCC, similarly to its HPV-negative counterpart, has a male predominance, with men suffering a three-to-five times higher incidence than women worldwide [7].HPV-positive HNSCC carries a favorable prognosis if compared to HPV-negative tumors. In fact, five-year survival rates for patients with advanced-stage HPV-positive HNSCC are 75-80%, versus values less than 50% in patients with similarly staged HPV-negative tumors [8,9]. The cause of the aforementioned different behavior is the different chemo-and radiosensitivity shown by the HPV-positive and HPV-negative HNSCCs. In fact, several clinical trials have shown that HPV-positive HNSCC patients have a better response to chemotherapy and radiation therapy than HPV-negative cases [10][11][12]. The reasons for this different behavior should be searched in the opposite genetic features which characterize the two types of tumors.In this review, we will analyze the genetics of both HPV-positive and HPV-negative HNSCC, highlighting their impact on the clinical behavior and finally on the therapeutic strategies. Genetics of HPV-Positive HNSCCCarcinogenesis, which is the complex process through which the normal cell is pushed to transform itself into a cancer cell, is very different between HPV-related and non-HPV-related HNSCC. Viral carcinogenesis in HNSCC is partly due to HPV infection, with the oropharynx being the most commonly involved site. HPV-mediated carcinogenesis is driven by a few viral oncoproteins expressed by high-risk HPV genotypes....

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“…The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) suffer from a scattered TORS availability in the region. Specifically, 10/21 HNC centers perform TORS; however, each center operates on fewer than 25 cases annually, and 9/10 centers report a high complication rate [ 33 ]. On the other hand, a late study showed that, between 2010 and 2016, the use of TORS for oropharyngeal cancer treatment in the United States nearly doubled [ 34 ].…”

Section: Tors Applications In Hncmentioning

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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Transoral Robotic Surgery in the Nordic Countries: Current Status and Perspectives

Cited by 8 publications

References 16 publications

Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Management of HPV-Related Squamous Cell Carcinoma of the Head and Neck: Pitfalls and Caveat

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

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