Utilizing Trans-Oral Robotic Surgery (TORS) in head and neck malignancy – is it practical in oropharyngeal squamous cell carcinoma (OPSCC)? A case report

Abstract

Introduction: Oropharyngeal squamous cell carcinoma (OPSCC) is often managed by multimodal methods, including open surgical resection and reconstruction in advanced cases. Trans-oral Robotic Surgery (TORS) was introduced to minimize and avoid complications caused by the open surgery method and chemo-radiation therapy in treating oropharyngeal squamous cell carcinoma (OPSCC). In Malaysia, TORS is still a new, rare, and limited surgical technique practiced in our healthcare system. Case Presentation: We present a case of the base of tongue lesion which presented with chronic globus sensation for four months associated with chronic dysphagia and cough. Endoscopy examination revealed a lobulated mass situated at the left side base of the tongue. Contrast Enhanced Computed Tomography (CECT) of the neck revealed an enhancing lesion at the same site. There were multiple subcentimeter cervical lymph nodes bilaterally from level II to level V. The patient underwent a TORS procedure using the da Vinci Surgery System for incisional biopsy. By using TORS, we were able to obtain a good tumor sample including the margins for the biopsy. Histopathology examination (HPE) of the sample reported moderate to poorly differentiated squamous cell carcinoma. Based on the HPE and CECT results, the patient was diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) with a clinical stage of T3N2cMx. Conclusion: Management strategies for patients with OPSCC continue to evolve to minimize the morbidities and complications of treatments. Minimally invasive surgical techniques such as TORS offer impressive functional and oncologic outcomes particularly for patients (therapeutic function) compared to the traditional method of treatments.