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Transoral robotic surgery demonstrates efficacy in head, neck cancers
Transoral robotic surgery appeared associated with favorable oncologic outcomes for patients with head and neck cancers, according to the results of a multi-institutional study.
Patients with oropharyngeal cancer derived the greatest benefit from transoral robotic surgery (TORS), a minimally invasive surgical technique, according to the researchers.
Due to the late effects associated with radiation therapy, researchers have reinvestigated the role of primary surgery for patients with head and neck cancers.
“The term transoral robotic surgery was coined by Weinstein and colleagues at The University of Pennsylvania, and since then many single institutions have found that TORS is safe and feasible and has good functional outcomes,” F. Christopher Holsinger, MD, professor and chair of head and neck surgery at Stanford University School of Medicine, and colleagues wrote. “Although several institutions have reported oncologic results after TORS, many of these reports are limited by small numbers, limited follow-up, or heterogeneity within the study population.”
Holsinger and colleagues conducted a retrospective review of records from patients undergoing TORS at 11 participating institutes. The surgical procedures took place between January 2007 and December 2012.
Locoregional control, disease-specific survival (DSS) and OS following TORS served as the primary endpoints.
The study included data from 410 patients (mean age, 59.6 years; 82% men). Approximately 88% of patients (n = 364) had oropharyngeal cancer, 338 of whom had information available regarding postoperative adjuvant therapy.
Seventy-two patients received radiation therapy plus chemotherapy and 106 patients received radiation therapy alone.
Approximately 78% of patients (n = 323) underwent neck dissection.
After a mean follow-up of 20 months, 18 patients experienced local recurrence, 15 patients experienced regional recurrence and 10 patients experienced distant recurrence.
Seventeen patients died of disease and 13 patients died of other causes.
The 2-year locoregional control rate was 91.8% (95% CI, 87.6-94.7). The 2-year DSS rate was 94.5% (95% CI, 90.6-96.8) and the OS rate was 91% (95% CI, 86.5-94).
Multivariate analyses found that women (P = .05) and patients with tumors arising in the tonsil (P = .01) experienced improved survival outcomes. The researchers linked smoking to worse overall all-cause mortality (P = .01).
Although older age and tobacco use appeared associated with locoregional recurrence and DSS, they did not remain significant on multivariate analysis.
The researchers acknowledged limitations of their study. Due to the retrospective study design, certain data pertaining to pathologic variables were missing. Further, the mean follow-up was less than 2 years.
“This large, multicenter collaborative study supports the role of transoral robotic head and neck surgery within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharynx cancer,” Holsinger and colleagues wrote. “Ongoing prospective clinical trials will provide further information regarding integrating robotic surgery into a treatment algorithm for optimal patient care.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.