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Advances in Surgery and Reconstruction: TORS, TLM

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Multidisciplinary Management of Head and Neck Cancer

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Abstract

Introduction: Transoral laser microsurgery and transoral robotic surgery have become common approaches to treating oropharyngeal squamous cell carcinoma. Early stage cancers are the best candidates for transoral resection.

Technique: Transoral oropharyngectomy of the tonsil or base of tongue requires adequate exposure and access, which may be limited by patient- and tumor-specific characteristics. Multiple robotic systems are available, each with their own advantages and disadvantages.

Outcomes: Oncologic outcomes of transoral surgery for oropharyngeal cancer are comparable to radiation or chemoradiotherapy based on available data. Functional outcomes from transoral surgery are consistently better than standard of care chemoradiotherapy when the patient is spared adjuvant radiation. Patients who receive transoral surgery with radiation may still achieve a functional benefit compared to definitive chemoradiotherapy, but the benefit is diminished.

Trials: Many ongoing trials are investigating the role of transoral resection in treatment de-escalation for human papillomavirus-associated oropharyngeal squamous cell carcinoma. The few trials that have been complete to date demonstrate very promising survival and functional outcomes using transoral surgery as a component of treatment de-escalation. Ongoing clinical trials will continue to elucidate the optimal role and efficacy of transoral surgery in treatment de-escalation.

Conclusion: Transoral surgery using laser microsurgery or robotic surgery is increasing in popularity for the treatment of early stage oropharyngeal squamous cell carcinoma. The use of these minimally invasive surgical approaches may expand as ongoing clinical trials are completed.

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Authors and Affiliations

  1. Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, IL, USA

    Adam Howard, Nishant Agrawal & Zhen Gooi

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  1. Adam Howard
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  2. Nishant Agrawal
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Correspondence to Zhen Gooi .

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  1. Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA

    Ravi A. Chandra

  2. Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA

    Ryan J. Li

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Howard, A., Agrawal, N., Gooi, Z. (2022). Advances in Surgery and Reconstruction: TORS, TLM. In: Chandra, R.A., Li, R.J. (eds) Multidisciplinary Management of Head and Neck Cancer. Springer, Cham. https://doi.org/10.1007/978-3-031-05973-5_3

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