Abstract
We analyzed the functional and oncologic outcomes of primary and salvage transoral robotic surgery (TORS) procedures, performed in three Belgian institutions with a similar philosophy. A total of 86 patients who underwent TORS between 24-12-2009 and 25-09-2015 were retrospectively reviewed. Descriptive statistics, overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS; Kaplan-Meier), and the variation of these outcomes according to whether patients had primary or salvage TORS were evaluated (univariate log-rank analysis). Of 86 patients, 56 (65.1%) underwent TORS as a primary treatment and 30 (34.9%) as a salvage procedure for recurrent or second primary cancer. Tumor location was mainly oropharynx (N = 63; 73.3%) followed by supraglottic larynx (N = 11; 12.8%), hypopharynx (N = 11; 12.8%), and glottic larynx (N = 1; 1.2%). In the up-front TORS group, most tumors were classified as cT1 (N = 23; 41.1%)/pT1 (N = 24; 42.9%) or cT2 (N = 27; 48.2%)/pT2 (N = 27; 48.2%) and cN0 (N = 18; 32.1%), cN1 (N = 13; 23.2%), or cN2 (N = 25; 44.6%). In the salvage TORS group, most tumors were cT1-rT1 (N = 18; 60.0%)/pT1-rpT1 (N = 18; 60.0%) or cT2-rT2 (N = 12; 40.0%)/pT2-rpT2 (N = 7; 23.3%) and cN0 (N = 25; 83.3%). Neck dissection was performed in 87.5% of primary cases and 30.0% of salvage cases. In the up-front TORS group, patients were postoperatively submitted to follow-up (N = 13; 23.2%) or received adjuvant radiotherapy, either as single modality (N = 26; 46.4%) or with concomitant cisplatin (N = 15; 26.8%). On the other hand, most salvage TORS patients did not receive any adjuvant therapy (N = 19; 63.3%). Mean and median follow-up was 23.1 and 21.2 months, respectively. Functional results were excellent (no definitive tracheostomy, long-term tube feeding in 1.8% of primary cases, and 20% of salvage cases). In the up-front TORS group, estimated 2-year OS was 88.5% (SE = 5.0%), 2-year DSS was 91.8% (SE = 4.6%) and 2-year DFS was 86.1% (SE = 5.3%). In the salvage TORS group, estimated 2-year OS was 73.5% (SE = 10.9%), 2-year DSS was 93.3% (SE = 6.4%), and 2-year DFS was 75.8% (SE = 9.7%). Comparing outcome of primarily treated patients to salvage patients, a non-statistically significant trend toward better OS (p = 0.262) and DFS (p = 0.139) was observed. This retrospective study confirms favorable oncologic and functional outcomes of TORS for selected head and neck malignancies, both in the primary and in the salvage setting.
Highlights
Classic open “en bloc” surgical treatment of most head and neck malignancies is often associated with considerable mutilation and functional adverse effects regarding speech, swallowing function, and respiration, leading to decreased quality of life
In the up-front transoral robotic surgery (TORS) group, patients were postoperatively submitted to follow-up (N = 13; 23.2%) or received adjuvant radiotherapy, either as single modality (N = 26; 46.4%) or with concomitant cisplatin (N = 15; 26.8%)
Transoral laser microsurgery (TLM) has been, mainly in Europe, a valid minimally invasive surgical technique to address selected malignancies of the upper aerodigestive tract since its introduction in the 1980s, it is the recent introduction of transoral robotic surgery (TORS), which has revived the interest to treat a selection of head and neck malignancies surgically through a minimally invasive approach
Summary
Classic open “en bloc” surgical treatment of most head and neck malignancies is often associated with considerable mutilation and functional adverse effects regarding speech, swallowing function, and respiration, leading to decreased quality of life. Various “landmark studies” have assessed non-surgical treatment for advanced-stage head and neck cancer, including advanced laryngeal, hypopharyngeal, and oropharyngeal squamous cell carcinoma (SCC) These studies evaluated “organ preservation protocols,” such as induction chemotherapy and subsequent radiotherapy (RT) [1, 2] or more recently concurrent chemoradiation (CRT) [3, 4] and reported oncologic results comparable to those obtained by the classic combination of surgery and postoperative RT. TORS for treatment of head and neck malignancies was introduced in 2006 and has become well established in recent years, especially for the resection of early-stage oropharyngeal or supraglottic SCC, yielding excellent oncologic and functional outcomes This makes primary TORS a possible alternative to non-surgical organ preservation regimens [9,10,11,12,13,14,15,16,17,18]. In this multicenter retrospective case series, we reviewed functional and oncologic outcomes of primary or up-front and salvage TORS procedures performed in three Belgian hospitals
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