Abstract
The aim of this systematic review with meta-analysis was to investigate the available literature on transoral approaches in the treatment of hypopharyngeal squamous cell carcinoma, with a special focus on transoral robotic surgery (TORS). A systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) check-list, and 15 studies were included. Five of the included studies evaluated TORS, while ten studies focused on transoral laser microsurgery (TLM) for the treatment of early or advanced stage hypopharyngeal cancer. Overall, survival rates of TLM and TORS studies, analyzed together in the cumulative meta-analysis, were 66.4% (95% confidence interval (CI) 54.3%–76.7%) at 36+ months of follow up. The TORS subgroup showed a higher cumulative survival rate (85.5%, 95% CI 55.8%–96.5%) compared to TLM (58.5%, 95% CI 46.6%–69.6%). Cumulative data showed that 29.3% (95% CI 24.0%–35.3%) of deaths were attributable to cancer. The results were similar between TLM and TORS studies. The larynx function preservation cumulative rate was 94.3% (95% CI 91.8%–96.1%). The results were similar among the two subgroups. The present review supports the use of transoral approaches in the treatment of hypopharyngeal cancer. TORS is oncologically sound and provides excellent functional results with low complication rates.
Highlights
Squamous cell carcinoma of the hypopharynx (SCCHP) constitutes 3% to 7% of head and neck cancers [1,2] and despite advancements in surgery and chemoradiotherapy treatment options, its prognosis remains poor
Mneed-.h2u01n9d, 8r,e2d56and forty-five studies were identified through a database search (Figure 1)
Cumulative data showed that 29.3% of deaths were attributable to cancer
Summary
Squamous cell carcinoma of the hypopharynx (SCCHP) constitutes 3% to 7% of head and neck cancers [1,2] and despite advancements in surgery and chemoradiotherapy treatment options, its prognosis remains poor. Due to the lack of symptoms in the early phase of the disease, the majority of hypopharyngeal cancers present at the advanced stage. This has important repercussions on survival rates, which greatly vary according to tumor stage. There is no agreement on the best treatment approach for hypopharyngeal cancer. Traditional open surgery approaches are associated with substantial morbidity. For this reason, it has been an ongoing debate as to which treatment options are best compared to others
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