MedWire News: Robotic surgery has shown early promise for the management of patients with oropharyngeal squamous cell carcinoma (OSCC), particularly those with human papillomavirus (HPV) infection, say researchers.
Their findings come from an observational study that examined long-term outcomes among 66 patients who were treated with transoral robotic surgery for OSCC arising in the tonsil or base of tongue.
The robotic approach was developed several years ago with the aim of improving access to hard-to-reach tumors such as those at the back of the throat, potentially obviating the need for open-neck surgery or extensive radiation.
In this study, Eric Moore (Mayo Clinic, Rochester, Minnesota, USA) and team reviewed functional and oncologic outcomes in all patients treated with the da Vinci robotic surgical system at their clinic between 2007 and 2009.
A total of 66 patients were included in the analysis, all of whom were followed up for at least 2 years.
The patients' mean age at baseline was 55.2 years, all but seven were men, 50% were current or former smokers, 72.1% were HPV positive, and 89.2% were positive for protein 16.
Preoperatively, most patients had stage T1 or T2 tumors, 86.4% had lymph node metastases, and 87.9% had advanced disease. Tumor subsites included 26 base-of-tongue tumors and 40 tonsillar tumors.
All patients underwent transoral robotic primary tumor resection, which enabled full exposure and complete resection in all cases. Surgical margins were clear in 54.5% of patients while the remainder required at least one further margin excision.
Patients routinely underwent neck dissection at the same time as transoral tumor resection and a subset of the patients also received adjuvant chemotherapy and/or radiation therapy.
In terms of outcomes, 64 patients were able to eat orally within 3 weeks of surgery. Just three patients needed a long-term gastrostomy tube use while one required a long-term tracheotomy.
At 2 years, rates of disease-specific survival and recurrence-free survival were 95.1% and 92.4%, respectively; at 3 years, estimated rates of local control and regional control were 97.0% and 94.0%, respectively.
Taken together, these data offer preliminary support for the viability of robotic surgery as a treatment for OSCC, Moore et al write in the Mayo Clinic Proceedings.
"This study demonstrates that excellent functional outcomes and disease control can be achieved with TORS as primary therapy for OSCC. Advantages of TORS include the ability to stage the tumor adequately, to eradicate the primary tumor and the involved lymph nodes reliably and completely in a single setting, and to add adjuvant therapy in a rational and individually designed manner."
They add: "Especially in nonsmoking patients with HPV-positive tumors, transoral surgery offers an opportunity to decrease morbidity without sacrificing tumor control."
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