Abstract
Background
The aim of this observational prospective study was to determine the technical feasibility, safety and adequacy of surgical margins for transoral robotic surgery (TORS) in oropharyngeal cancers.
Methods
From March 2013 to May 2014, 60 patients with oropharyngeal lesions underwent TORS with or without neck dissection using the ‘DaVinci’ robot. Patients were observed and data recorded on surgical time, blood loss, complications and functional outcome of patients.
Results
All 60 patients underwent TORS, with neck dissection performed in 45 of the patients. A positive margin was seen in two patients (3.3 %). Intent to treatment was radical in 42 patients and salvage in 18 patients. None of the patients required tracheostomy, and one patient (1.66 %) died postoperatively. Postoperative complications in the form of primary haemorrhage required active intervention in three patients. Average estimated blood loss was 26.5 ± 31.1 ml. Postoperatively, all patients had adequate swallowing and speech function with nasal twang reported in three patients on long-term follow up. Patients started tolerating oral feeds within a week of procedure (mean 3.96 days), with the nasogastric tube removed on the ninth postoperative day (mean 9.19 days). No long-term gastrostomy tube dependency was reported.
Conclusion
TORS is a safe, feasible, minimally invasive procedure in patients with oropharyngeal cancers. It has the least morbidity and offers benefits in terms of avoidance of tracheostomy tube, prolonged Ryle’s tube and gastrostomy dependency.
Similar content being viewed by others
References
National Cancer Registry Programme (ICMR) (2008). Consolidated report of population based cancer registries: 2004-05. ICMR, Bangalore
Warnakulasuriya S (2009) Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 45:309–316
Gourin CG, Johnson JT (2001) Surgical treatment of squamous cell carcinoma of the base of tongue. Head Neck 23:653–660
Goguen LA, Posner MR, Norris CM et al (2006) Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg 134:916–922
Gillespie MB, Brodsky MB, Day TA et al (2004) Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope 114:1362–1367
Weinstein GS, O’Malley BW Jr, Hockstein NG (2005) Transoral robotic surgery: supraglottic laryngectomy in a canine model. Laryngoscope 115:1315–1319
Weinstein GS, O’Malley BW Jr, Desai SC et al (2009) Transoral robotic surgery: does the ends justify the means? Curr Opin Otolaryngol Head Neck Surg 17:126–131
Genden EM, Desai S, Sung CK (2009) Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck 31:283–289
Moore EJ, Olsen KD, Kasperbauer JL (2009) Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope 119:2156–2164
Boudreaux BA, Rosenthal EL, Magnuson JS et al (2009) Robot-assisted surgery for upper aerodigestive tract neoplasms. Arch Otolaryngol Head Neck Surg 135:397–401
Parsons JT, Mendenhall WM, Stringer SP et al (2002) Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both. Cancer 94:2967–2980
Machtay M, Perch S, Markiewicz D et al (1997) Combined surgery and postoperative radiotherapy for carcinoma of the base of radiotherapy for carcinoma of the base of tongue: analysis of treatment outcome and prognostic value of margin status. Head Neck 19:494–499
Denittis AS, Machtay M, Rosenthal DI et al (2001) Advanced oropharyngeal carcinoma treated with surgery and radiotherapy: oncologic outcome and functional assessment. Am J Otolaryngol 22:329–335
Machtay M, Rosenthal DI, Hershock D et al (2002) Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania phase II trial. J Clin Oncol 20:3964–3971
Koch WM (2000) Head and neck surgery in the era of organ preservation therapy. Semin Oncol 27[Suppl 8]:5–12
Nguyen NP, Moltz CC, Frank C et al (2004) Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol 15(3):383–388
Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098
Laccourreye O, Hans S, Menard M et al (2005) Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region. Arch Otolaryngol Head Neck Surg 131:592–599
Steiner W, Fierek O, Ambrosch P et al (2003) Transoral laser microsurgery for squamous cell carcinoma of the base of tongue. Arch Otolaryngol Head Neck Surg 129:36–43
Grant DG, Salassa JR, Hinni ML et al (2006) Carcinoma of the tongue base treated by transoral laser microsurgery, Part 1: a prospective analysis of oncologic and functional outcomes. Laryngoscope 116:2150–2155
Iseli TA, Kulbersh BD, Iseli CE et al (2009) Functional outcomes after transoral robotic surgery for head and neck cancer. Otolaryngol Head Neck Surg 141:166–171
Weinstein GS, O’Malley BW, Snyder W et al (2007) Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 133:1220–1226
Moore EJ, Henstrom DK, Olsen KD et al (2009) Transoral resection of tonsillar squamous cell carcinoma. Laryngoscope 119:508–515
Preuss SF, Cramer K, Klussmann JP et al (2009) Transoral laser surgery for laryngeal cancer: outcome, complications and prognostic factors in 275 patients. Eur J Surg Oncol 35:235–240
Grant DG, Salassa JR, Hinni ML et al (2006) Carcinoma of the tongue base treated by transoral laser microsurgery, part 2: persistent, recurrent and second primary tumors. Laryngoscope 116:2156–2161
Weinstein GS, O’Malley BW, Cohen MA et al (2010) Transoral robotic surgery for advanced oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 136(11):1079–1085
Langendijk JA, Doornaert P, Rietveld DH et al (2009) A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 90(2):189–195
Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:3582–3589
Weinstein GS, Quon H, O’Malley BW Jr et al (2010) Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the University of Pennsylvania transoral robotic surgery trial. Laryngoscope 120:1749–1755
Weinstein GS, Quon H, Newman HJ et al (2012) Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg 138(7):628–634
More YI, Tsue TT, Girod DA et al (2013) Functional swallowing outcome following transoral robotic surgery vs primary chemoradiotherapy in patients with advanced-stage oropharynx and supraglottic cancers. JAMA Otolaryngol Head Neck Surg 139(1):43–48
White HN, Moore EJ, Rosenthal EL et al (2010) Transoral robotic-assisted surgery for head and neck squamous cell carcinoma: one- and 2-year survival analysis. Arch Otolaryngol Head Neck Surg 136(12):1248–1252
Greven KM, White DR, Browne JD et al (2008) Swallowing dysfunction is a common sequelae after chemoradiation therapy for oropharynx carcinoma. Am J Clin Oncol 31:209–212
Lawson JD, Otto K, Chen A et al (2008) Concurrent platinum based chemotherapy and simultaneous modulated accelerated radiation therapy for locally advanced squamous cell carcinoma of the tongue base. Head Neck 30(3):327–335
De Arruda FF, Puri DR, Zhung J et al (2006) Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys 64(2):363–373
Rusthoven KE, Raben D, Ballonoff A et al (2008) Effect of radiation techniques in treatment of oropharynx cancer. Laryngoscope 118(4):635–639
Leonhardt FD, Quon H, Abrahão M et al (2012) Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck 34(2):146–154
Sobol SM, Freeman R, Thawley S et al (1982) Management of inadvertent injury to the carotid artery during head and neck surgery. Head Neck Surg 4:475–482
Ketcham AS, Hoye RC (1965) Spontaneous carotid artery hemorrhage after head and neck surgery. Am J Surg 110:649–655
Shumrick DA (1973) Carotid artery rupture. Laryngoscope 83:1051–1061
Joseph DL, Shumrick DL (1973) Risks of head and neck surgery in previously irradiated patients. Arch Otolaryngol 97:381–384
O’Brien CJ, Nettle WJ, Lee KK (1993) Changing trends in the management of carcinoma of the oral cavity and oropharynx. Aust N Z J Surg 63:270–274
Weber RS, Berkey BA, Forastiere A et al (2003) Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 129:44–49
Aubry K, Yachine M, Perez AF et al (2011) Transoral robotic surgery for head and neck cancer: a series of 17 cases. Eur Ann Otorhinolaryngol Head Neck Dis 128(6):290–296
Moore EJ, Olsen KD, Martin EJ (2011) Concurrent neck dissection and transoral robotic surgery. Laryngoscope 121:541–544
Acknowledgements
None.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Dabas, S., Dewan, A., Ranjan, R. et al. Transoral robotic surgery in management of oropharyngeal cancers: a preliminary experience at a tertiary cancer centre in India. Int J Clin Oncol 20, 693–700 (2015). https://doi.org/10.1007/s10147-014-0774-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-014-0774-3