Transoral Robotic Surgery for Pharyngeal and Laryngeal Cancers-A Prospective Medium-Term Study.

Chen-Chi Wang,Kai-Li Liang,Chien-Chih Chen,Wen-Jiun Lin,Shang-Heng Wu,Shih-An Liu,Yi-Chun Liu

doi:10.3390/jcm10050967

Abstract

Transoral robotic surgery (TORS) has been used for treating pharyngeal and laryngeal cancers for many years. However, the application of neoadjuvant chemotherapy (NACT) before TORS, the sparing rate of adjuvant irradiation after TORS, and the long-term oncologic/functional outcomes of TORS are seldom reported. From September 2014 to May 2018, 30 patients with clinical T1 to T3 cancers of oropharynx (7), larynx (3), and hypopharynx (20) were prospectively recruited for TORS in a tertiary referral medical center. Twelve (40%) patients had clinical early stage (I or II) disease, and 18 (60%) patients had late-stage (III or IV) disease. All 30 patients were suggested to receive TORS with neck dissection. Cisplatin-based NACT was given to 11 patients before the surgery, and it led to a 100% reduction in tumor size. Only 40% of patients needed adjuvant irradiation with a mean dosage of 5933 cGY after TORS. After a mean follow up of 38.9± 14.7 months, the Kaplan–Meier method estimated 5-year disease-specific survival, and organ preservation was 86.3% and 96.2%, respectively. Twenty-five patients were alive without tracheostomy and tube feeding. We found that NACT is a potential method for facilitating tumor resection and TORS effectively de-escalated adjuvant irradiation with a satisfactory 5-year survival and functional outcomes.

Highlights

Organ preservation is a key objective in the nonsurgical management of pharynx and larynx cancers
Since the Veteran’s Affairs (VA) larynx preservation study [1], radiation combined with chemotherapy has become a popular organ preservation management technique for pharynx and larynx cancers
The demographic data, peri-operation information, adjuvant therapy, and postoperative follow-up data were recorded in our database, and medium-term treatment outcomes were analyzed to elucidate the effectiveness of this surgical organ preservation strategy

Summary

Introduction

Organ preservation is a key objective in the nonsurgical management of pharynx and larynx cancers. Since the Veteran’s Affairs (VA) larynx preservation study [1], radiation combined with chemotherapy has become a popular organ preservation management technique for pharynx and larynx cancers. Organ preservation does not always result in functional preservation. Acute toxicity of chemoradiation such as mucositis had a high rate of 80% in the results from 6181 patients in a systematic literature review by Trotti A et al [2]. Acute toxicities may persist chronically, it is often under-reported or underestimated according to a trial report [3].

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