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Transoral robotic surgery alone acceptable for oropharyngeal cancer
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Transoral robotic surgery, or TORS, alone resulted in acceptable short- and long-term quality-of-life outcomes in well-chosen patients with oropharyngeal squamous cell carcinoma, according to the results of a retrospective analysis.
“The use of TORS has been associated with decreased length of hospitalization, tracheostomy tube requirement during treatment and permanent gastronomy tube requirement,” Umamaheswar Duvvuri, MD, PhD, of the department of otolaryngology-head and neck surgery at the University of Pittsburgh Medical Center, and colleagues wrote. “Faster postoperative recovery after TORS may decrease treatment duration and toxic effects associated with adjuvant radiotherapy and chemoradiotherapy.”
The effect of TORS as sole treatment on quality-of-life outcomes had not been adequately studied, according to study background.
Duvvuri and colleagues evaluated data from 34 patients (mean age, 59 years) who received TORS as their primary treatment for oropharyngeal squamous cell carcinoma at the University of Pittsburgh Medical Center. Ninety-four percent of the patients were white and 76% were men. Most patients had T1 (59%) or T2 (38%) and N0 (38%) or N1 (47%) disease.
Patients who received postoperative chemoradiotherapy and radiotherapy were excluded from the analysis.
Patients completed The University of Washington Quality of Life questionnaire preoperatively and at 1-month, 6-month, 12-month and 24-month postoperative checkups.
Median follow-up was 14 months.
Global quality-of-life scores generally increased during follow-up.
General quality-of-life areas — including pain, swallowing, activity and chewing — showed consistent improvement during follow-up. A significant improvement in chewing scores occurred in the first 1 to 12 months after surgery (P = .048) and a positive chewing score was displayed over time (P = .05). Significant pain improvements occurred at 1 to 6 months (P = .006) and 12 months (P = .01) after surgery; however, this score did not continue to improve over time. Swallowing scores demonstrated improvement from 1 to 6 months (P = .047) and 24 months (P = .048) after surgery. The median activity score also improved over time (P = .03).
Two patients (6%) died during follow-up, one due to disease progression and the other due to myocardial infarction. Two patients required temporary gastronomy tube placement, and no patients required tracheostomy.
The researchers said the small cohort size and the fact that not all patients completed quality-of-life survey forms are limitations to these data. Quality-of-life scores also were evaluated in a grouped fashion rather than individually. The researchers also cited the lack of a comparison arm as a potential limitation.
“To our knowledge, the present study is the first to report a statistically significant improvement in pain in the short term with lasting long-term relief among patients who undergo TORS without adjuvant therapy,” Duvvuri and colleagues concluded. “It appears that the addition of radiotherapy or chemoradiotherapy following TORS hampers recovery from pain associated with surgery, but TORS alone is associated with short-term pain and good long-term recovery.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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