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Laryngoscope. 2019 Aug;129(8):1844-1855. doi: 10.1002/lary.27740. Epub 2018 Dec 21.

Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption.

Li H1,2, Torabi SJ1,2, Park HS1,3,4, Yarbrough WG1,2,3, Mehra S1,2,3, Choi R1,2, Judson BL1,2,3.

Author information

1
Yale University School of Medicine, New Haven, Connecticut, U.S.A.
2
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
3
Yale Cancer Center, New Haven, Connecticut, U.S.A.
4
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, U.S.A.

Abstract

OBJECTIVES:

To compare long-term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM).

STUDY DESIGN:

A retrospective analysis of the National Cancer Database (2010-2014).

METHODS:

Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi-square tests; Kaplan-Meier log-rank test; and Cox multivariate, logistic regression, and multinomial regression modeling.

RESULTS:

We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001). TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303).

CONCLUSION:

The advantages of TORS for early-stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy.

LEVEL OF EVIDENCE:

NA Laryngoscope, 129:1844-1855, 2019.

KEYWORDS:

Transoral robotic surgery; head and neck cancer; oropharyngeal cancer; robotic surgery

PMID:
30575965
DOI:
10.1002/lary.27740
[Indexed for MEDLINE]

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