Transoral Robotic Surgery Total Laryngectomy: Evaluation of Functional and Survival Outcomes in a Retrospective Case Series at a Single Institution

Abstract

Background: Transoral robotic surgery total laryngectomy (TORS-TL) is a minimally invasive endoscopic surgical approach which can theoretically minimise the morbidity of large external incisions and limit dissection of tissue planes so as to reduce the risk of pharyngocutaneous fistulae related to poor tissue healing secondary to radiation soft tissue injury or malnutrition. The purpose of this paper was to report our experience with this uncommon surgical approach. Methods: A retrospective chart review was conducted at a single institution to evaluate the functional and survival outcomes of a series of patients who underwent TORS-TL. Results: TORS-TL was performed on 5 patients. Two patients had total laryngectomy for recurrent aspiration secondary to neurological disorders, 1 patient had an adenoid cystic carcinoma of the subglottis, 1 patient had a low-grade subglottic chondrosarcoma, and 1 patient had a T2 local recurrence of glottic squamous cell carcinoma following treatment with primary chemoradiotherapy. Conclusions: TORS-TL is a feasible and safe treatment option with possible advantages for carefully selected patients in experienced hands.

Robotic versus conventional neck dissection: A systematic review and meta‐analysis

“…Because acceptance of this technology has grown in the field of head and neck surgery, so too have its indications. Robotic approaches have been widely adopted in transoral surgery, most often utilized in procedures such as radical tonsillectomy, base‐of‐tongue resection, supraglottic laryngectomy, and inset of free tissue transfer, among others …”

Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis

“…On detailed review of full text articles, many records were ineligible as they were review articles, did not report any TORS salvage cases, the salvage cases were indistinguishable from the primary cases/combined cohort, there were insufficient survival data, reports were only conference abstracts, related to nasopharyngeal carcinoma only, or the reports were superseded by more contemporary publications from the relevant institutions . A total of eight studies met the eligibility criteria and have been presented in the results …”

“…Table summarizes the characteristics of the studies included in this systematic review. The studies were published between 2013 and 2018 and originate from centres in the United States, Europe, India, and Australia . Two of the studies were multi‐institutional .…”

“…The eight studies included 161 cases in total, ranging from a single eligible case to a cohort of 64 patients. In three studies, the final number of cases eligible for inclusion in this review was small (1, 2, and 4 cases). All these studies satisfied the predetermined eligibility criteria, presenting valid outcome data which were discernible for the included cases.…”

“…Velopharyngeal insufficiency is further impaired by low rates of free flap reconstruction in these TORS oropharyngeal resections, giving less tissue bulk at the junction, and reduced tissue pliability, as a result of previous irradiation . Two of the included studies made comment on voice outcomes: Dabas et al reported altered resonance in 10% of patients in the immediate postoperative period that persisted into the long‐term and Krishnan and Krishnan reported “poor voice outcomes” following secondary tracheoesophageal puncture in their single case of TORS total laryngectomy performed for recurrent glottic SCC. Full functional outcome data, including any impact on speech production, should be presented to patients considering TORS for recurrence, to enable informed decision making.…”