OP102: Transoral robotic surgery in oropharyngeal cancer

Abstract

In recent years, transoral robotic surgery (TORS) has been used for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening the survival. This prospective single-center cohort study described TORS in selected tumors of the tongue base in order to assess safety, efficacy and functional outcome of the procedure. From October 2010 to February 2012, TORS was performed in 13 consecutive patients affected by T1-T2 tumors of the base of the tongue. This procedure was applicable in all cases. The clinical stage demonstrated: 8 T1 tumors and 5 T2 tumors. Neck node metastases were clinically evident in 6 cases (7 N0, 1 N1, 4 N2b and 1 N2c). The final pathology report confirmed a malignancy in all cases (11 squamous cell carcinoma and 2 mucoepidermoid carcinoma). Negative-margin resections were obtained in all cases but in one with close margins. Synchronous lymph node neck dissections were performed in seven cases (six monolateral, one bilateral). Patients underwent temporary tracheostomies for a mean time of 6 days. Naso-gastric feeding tubes were positioned in 10/13 (76.9%) patients for a mean time of 7.5 days. The average time to carry out the TORS procedure was 95 min (set-up time 25 min; TORS 70 min). No deaths occurred. Surgical complications were observed in four cases (postoperative bleedings in three cases and intraoperative anaphilactic shock in one case). Median hospital stay was 9 days. All patients had good functional outcomes. Adjuvant treatment was indicated in 5/13 cases (35.4%). TORS represents a good tool for staging and treating neoplasm of the base of the tongue. The transoral removal is safe and can radically remove limited oropharyngeal tumors of the tongue base with good functional outcomes. The operating costs can be relatively high but are related to the number of procedures per year, however the advantages to patients seem to justify the procedure. TORS can represent the definitive treatment in selected T1–T2 cases of base of the tongue tumors without adverse features. and allow the possibility for the deintensification of adjuvant treatments.