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European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 2, pp 463–471 | Cite as

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

  • Katherine A. Hutcheson
  • F. Christopher Holsinger
  • Michael E. Kupferman
  • Jan S. Lewin
Head and Neck

Abstract

Summarize functional outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal cancer (OPC). A systematic review was conducted. The MEDLINE database was searched (MeSH terms: TORS, pharyngeal neoplasms, oropharyngeal neoplasms). Peer-reviewed human subject papers published through December 2013 were included. Exclusion criteria were as follows: (1) case report design (n < 10), (2) review article, or (3) technical, animal, or cadaver studies. Functional outcomes extracted included feeding tube dependence, swallow examination findings, speech ratings, velopharyngeal insufficiency, pneumonia, and oral intake measures. Twelve papers comprising 441 patients with OPC treated with TORS ± adjuvant therapy were included. Feeding tube rates were the most commonly reported functional outcome. Excluding prophylactic placement, 18–39 % of patients required gastrostomy placement, typically during adjuvant therapy. Chronic gastrostomy dependence ranged from 0 to 7 % (mean follow-up 11–26 months), regardless of disease stage. Composite MD Anderson Dysphagia Inventory (MDADI) scores ranged from 65.2 to 78 (89 patients, 3 series, mean follow-up 12–13 months). Videofluoroscopic swallowing studies were not systematically reported. Incidence of postoperative pneumonia was 0–7 %. Predictors of swallowing function included baseline function, T-stage, N-stage, tongue base primary tumors, and adjuvant chemoradiation. Rates of transient hypernasality were 4–9 %. A single study suggested dose-dependent effects of adjuvant therapy (none, radiation alone, chemoradiation) on diet scores at 6 and 12 months. Crude end points of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes, depending on the functional measure reported.

Keywords

Transoral robotic surgery Oropharyngeal cancer Functional outcome Swallowing 

Abbreviations

TORS

Transoral robotic surgery

IMRT

Intensity-modulated radiotherapy

Notes

Acknowledgments

The support was provided by the UT Health Innovation for Cancer Prevention Research Fellowship, The University of Texas School of Public Health—Cancer Prevention and Research Institute of Texas (CPRIT) grant #RP101503 (K.A.H). The authors thank Ms. Janet Hampton for help in preparation of the manuscript.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Katherine A. Hutcheson
    • 1
  • F. Christopher Holsinger
    • 2
  • Michael E. Kupferman
    • 1
  • Jan S. Lewin
    • 1
  1. 1.Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Otolaryngology-Head and Neck SurgeryStanford School of MedicineStanfordUSA

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