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Otolaryngol Head Neck Surg. 2014 Jun;150(6):968-75. doi: 10.1177/0194599814525747. Epub 2014 Mar 11.

Transoral Robotic Surgery: A Population-Level Analysis.

Author information

1
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
2
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
3
The Center for Head and Neck Oncology, New York Head and Neck Institute, Northshore Health System, New York, New York, USA.
4
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA benjamin.judson@yale.edu.

Abstract

OBJECTIVE:

(1) To determine baseline demographic, geographic, clinical, and pathologic characteristics of patients who had transoral robotic surgery (TORS) for oropharyngeal cancer. (2) To analyze margin status and unplanned readmission after TORS versus nonrobotic surgery.

STUDY DESIGN:

Retrospective database review.

SETTING:

National Cancer Database (2010-2011).

SUBJECTS AND METHODS:

Searching the National Cancer Database for adults with oropharyngeal cancer, we identified 877 patients who had TORS and 4269 patients who had nonrobotic surgery. Outcomes of interest included likelihood of adjuvant therapy, margin status, and unplanned readmission. Statistical analysis included chi-square, t tests, and multivariate regression.

RESULTS:

From 2010 to 2011, there was a 67% increase in the use of TORS for oropharyngeal cancer. Compared with patients who had nonrobotic surgery, TORS patients were more likely to be at academic centers (80.8% vs 49.1%, P < .001), to have private insurance (62.2% vs 57.4%, P < .001), and to have human papilloma virus (HPV)-positive tumors (48.3% vs 27.1%, P < .001). TORS (odds ratio, 0.50; 95% CI, 0.39-0.63) and HPV positivity (odds ratio, 0.73; 95% CI, 0.53-0.99) were independently associated with decreased likelihood of adjuvant chemoradiation versus radiation therapy. TORS patients were less likely to have positive margins than were patients who had nonrobotic surgery (20.2% vs 31.0%, P < .001). High-volume TORS centers had lower rates of positive margins (15.8% vs 26.1%, P < .001) and unplanned readmissions (3.1% vs 6.1%, P < .03) than did low-volume centers.

CONCLUSIONS:

TORS is being rapidly adopted by academic and community cancer centers. TORS is associated with a lower rate of positive margins than nonrobotic surgery, and high-volume centers have the lowest rates of positive margins and unplanned readmissions.

KEYWORDS:

National Cancer Data Base; adjuvant therapy; margins; oropharyngeal cancer; transoral robotic surgery; unplanned readmission

PMID:
24618503
DOI:
10.1177/0194599814525747
[Indexed for MEDLINE]

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