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Salvage transoral robotic surgery in recurrent oropharyngeal carcinoma: a single-center retrospective study

  • Head and Neck
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Abstract

Purpose

Salvage surgery is still the best therapeutic option for resectable recurrent oropharyngeal squamous cell carcinoma (rOPSCC). Transoral robotic surgery may potentially reduce the morbidity of standard open approaches. The aim of the study is to present oncological and functional outcomes of a monocentric experience in salvage transoral robotic surgery.

Methods

We performed a single-center retrospective analysis of patients submitted to transoral robotic salvage surgery with or without neck dissection for cT1-3 rOPSCC. We investigated complication rate, survival outcomes (Overall Survival, Disease Specific Survival, Loco-Regional Recurrence Free Survival) and functional outcomes (tracheal tube and/or gastrostomy dependence).

Results

Sixty-one patients were included in the analysis. No major complications or perioperative deaths were recorded. The estimated 2-year OS was 76.7%, DSS 81.8% and LRRFS 50.5%. In multivariable analysis rpT, PNI (perineural infiltration) and HPV-positivity were significantly associated with LRRFS (Hazard Ratios: T3 vs T1 6.43, PNI yes vs no 4.19, HPV+ yes vs no 2.63). At last follow up, 97% of patients were tracheal tube-free, while 93% were gastrostomy-free.

Conclusion

Transoral robotic salvage surgery is a successful treatment in selected patients affected by rOPSCC because it grants good oncologic and functional outcomes.

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Data available on request due to privacy/ethical restrictions.

References

  1. Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M (2014) HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Italy. 34(5):299–309

    CAS  Google Scholar 

  2. Zhang Y, Fakhry C, Duza G (2021) Projected association of human papillomavirus vaccination with oropharynx cancer incidence in the US, 2020–2045. JAMA Oncol. 7(10):e212907. https://doi.org/10.1001/jamaoncol.2021.2907

    Article  PubMed  PubMed Central  Google Scholar 

  3. Xu L, Dahlstrom KR, Lairson DR, Sturgis EM (2019) Projected oropharyngeal carcinoma incidence among middle-aged US men. Head Neck. 41(9):3226–3234. https://doi.org/10.1002/hed.25810

    Article  PubMed  Google Scholar 

  4. Schuman A, Anderson KS, Day AT, Ferrell J, Sturgis EM, Dahlstrom KR (2022) Is 2045 the best we can do? Mitigating the HPV-related oropharyngeal cancer epidemic. Expert Rev Anticancer Ther. 22(7):751–761. https://doi.org/10.1080/14737140.2022.2088514

    Article  CAS  PubMed  Google Scholar 

  5. Dowthwaite S, Jackson J, Dzienis M, Khoo E, Cronin M, Guazzo E (2023) Management of recurrent HPV-positive oropharyngeal squamous cell carcinoma: a contemporary review. Curr Oncol Rep. 25(5):501–510. https://doi.org/10.1007/s11912-023-01386-5

    Article  CAS  PubMed  Google Scholar 

  6. Lupato V, Giacomarra V, Alfieri S, Fanetti G, Polesel J (2022) Prognostic factors in salvage surgery for recurrent head and neck cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 169:103550. https://doi.org/10.1016/j.critrevonc.2021.103550

    Article  PubMed  Google Scholar 

  7. Baskin RM, Boyce BJ, Amdur R et al (2018) Transoral robotic surgery for oropharyngeal cancer: patient selection and special considerations. Cancer Manag Res. 10:839–846. https://doi.org/10.2147/CMAR.S118891

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bossi P, Alfieri S, Strojan P et al (2019) Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: a review of the literature. Crit Rev Oncol Hematol. 137:84–91. https://doi.org/10.1016/j.critrevonc.2019.01.018

    Article  PubMed  Google Scholar 

  9. Kreinbrink PJ, Lewis LM, Redmond KP, Takiar V (2022) Reirradiation of recurrent and second primary cancers of the head and neck: a review of the contemporary evidence. Curr Treat Options Oncol. 23(3):295–310. https://doi.org/10.1007/s11864-021-00936-y

    Article  PubMed  Google Scholar 

  10. Burtness B, Harrington KJ, Greil R et al (2019) Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 394(10212):1915–1928. https://doi.org/10.1016/S0140-6736(19)32591-7

    Article  CAS  PubMed  Google Scholar 

  11. Zafereo M (2014) Surgical salvage of recurrent cancer of the head and neck. Curr Oncol Rep. 16(5):386. https://doi.org/10.1007/s11912-014-0386-0

    Article  PubMed  Google Scholar 

  12. Agra IM, Carvalho AL, Pontes E et al (2003) Postoperative complications after en bloc salvage surgery for head and neck cancer. Arch Otolaryngol Head Neck Surg. 129(12):1317–21. https://doi.org/10.1001/archotol.129.12.1317

    Article  PubMed  Google Scholar 

  13. Hamoir M, Schmitz S, Suarez C et al (2018) The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. Cancers (Basel). 10(8):10080267. https://doi.org/10.3390/cancers10080267

    Article  Google Scholar 

  14. Lee SC, Shores CG, Weissler MC (2008) Salvage surgery after failed primary concomitant chemoradiation. Curr Opin Otolaryngol Head Neck Surg. 16(2):135–40. https://doi.org/10.1097/MOO.0b013e3282f495b6

    Article  PubMed  Google Scholar 

  15. Clayburgh DR, Gross N (2013) Surgical innovations. Otolaryngol Clin North Am. 46(4):615–28. https://doi.org/10.1016/j.otc.2013.04.003

    Article  PubMed  Google Scholar 

  16. Patel SN, Cohen MA, Givi B et al (2016) Salvage surgery for locally recurrent oropharyngeal cancer. Head Neck. 38(Suppl 1):E658-64. https://doi.org/10.1002/hed.24065

    Article  PubMed  Google Scholar 

  17. Kostrzewa JP, Lancaster WP, Iseli TA, Desmond RA, Carroll WR, Rosenthal EL (2010) Outcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope. 120(2):267–72. https://doi.org/10.1002/lary.20743

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dean NR, Rosenthal EL, Carroll WR et al (2010) Robotic-assisted surgery for primary or recurrent oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 136(4):380–4. https://doi.org/10.1001/archoto.2010.40

    Article  PubMed  Google Scholar 

  19. Williamson A, Jashek-Ahmed F, Hardman J, Paleri V (2023) Functional and quality-of-life outcomes following salvage surgery for recurrent squamous cell carcinoma of the head and neck: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-023-08056-z

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goodwin WJ (2000) Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope. 110(3 Pt 2 Suppl 93):1–18. https://doi.org/10.1097/00005537-200003001-00001

    Article  PubMed  Google Scholar 

  21. White H, Ford S, Bush B et al (2013) Salvage surgery for recurrent cancers of the oropharynx: comparing TORS with standard open surgical approaches. JAMA Otolaryngol Head Neck Surg. 139(8):773–8. https://doi.org/10.1001/jamaoto.2013.3866

    Article  PubMed  Google Scholar 

  22. Grant DG, Salassa JR, Hinni ML, Pearson BW, Hayden RE, Perry WC (2008) Transoral laser microsurgery for recurrent laryngeal and pharyngeal cancer. Otolaryngol Head Neck Surg. 138(5):606–13. https://doi.org/10.1016/j.otohns.2007.12.046

    Article  PubMed  Google Scholar 

  23. van Weert S, Leemans CR (2021) Salvage surgery in head and neck cancer. Oral Dis. 27(1):117–124. https://doi.org/10.1111/odi.13582

    Article  PubMed  Google Scholar 

  24. Edge SB (2010) AJCC cancer staging manual. Springer, Berlin

    Google Scholar 

  25. Gross ND, Hanna EY (2017) The role of surgery in the management of recurrent oropharyngeal cancer. Recent Results Cancer Res. 206:197–205. https://doi.org/10.1007/978-3-319-43580-0_15

    Article  PubMed  Google Scholar 

  26. Giger R, Fink R, Demattè M, Visini M, Elicin O, Anschuetz L (2021) Outcome of salvage therapy in isolated regional recurrence in head and neck squamous cell carcinoma. Laryngoscope. 131(1):67–72. https://doi.org/10.1002/lary.28550

    Article  PubMed  Google Scholar 

  27. Zafereo ME, Hanasono MM, Rosenthal DI et al (2009) The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx. Cancer. 115(24):5723–33. https://doi.org/10.1002/cncr.24595

    Article  PubMed  Google Scholar 

  28. Bachar GY, Goh C, Goldstein DP, O’Sullivan B, Irish JC (2010) Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol. 267(2):295–301. https://doi.org/10.1007/s00405-009-1070-0

    Article  PubMed  Google Scholar 

  29. Ihara Y, Crary MA, Madhavan A et al (2018) Dysphagia and oral morbidities in chemoradiation-treated head and neck cancer patients. Dysphagia. 33(6):739–748. https://doi.org/10.1007/s00455-018-9895-6

    Article  PubMed  Google Scholar 

  30. Agra IM, Carvalho AL, Ulbrich FS et al (2006) Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck. 28(2):107–13. https://doi.org/10.1002/hed.20309

    Article  PubMed  Google Scholar 

  31. Hardman J, Liu Z, Brady G et al (2020) Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—systematic review and meta-analysis. Head Neck. 42(5):1089–1104. https://doi.org/10.1002/hed.26100

    Article  PubMed  Google Scholar 

  32. Hardman JC, Holsinger FC, Brady GC et al (2022) Transoral robotic surgery for recurrent tumors of the upper aerodigestive tract (RECUT): an international cohort study. J Natl Cancer Inst. 114(10):1400–1409. https://doi.org/10.1093/jnci/djac130

    Article  PubMed  PubMed Central  Google Scholar 

  33. U.S. Department of Health and Human Services, Food and Drug Administration, Oncology Center of Excellence (2018) Clinical Trial Endpoints for the Approval of Cancer Drugs and Biologics Guidance for Industry. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/clinical-trial-endpoints-approval-cancer-drugs-and-biologics. Accessed 16 Oct 2023

  34. Dabas S, Dewan A, Ranjan R, Dewan AK, Shukla H, Sinha R (2015) Salvage transoral robotic surgery for recurrent or residual head and neck squamous cell carcinoma: a single institution experience. Asian Pac J Cancer Prev. 16(17):7627–32. https://doi.org/10.7314/apjcp.2015.16.17.7627

    Article  PubMed  Google Scholar 

  35. Asairinachan A, O’Duffy F, Fua T, Magarey MJR, Dixon BJ (2021) Salvage transoral robotic surgery in early-stage oropharyngeal recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol. 132(1):18–25. https://doi.org/10.1016/j.oooo.2021.01.013

    Article  PubMed  Google Scholar 

  36. Guo T, Kang SY, Cohen EEW (2022) Current perspectives on recurrent HPV-mediated oropharyngeal cancer. Front Oncol. 12:966899. https://doi.org/10.3389/fonc.2022.966899

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Gorphe F, Simon C (2019) A systematic review and meta-analysis of margins in transoral surgery for oropharyngeal carcinoma. Oral Oncol. 98:69–77. https://doi.org/10.1016/j.oraloncology.2019.09.017

    Article  PubMed  Google Scholar 

  38. Fakhry C, Zhang Q, Nguyen-Tan PF et al (2014) Human papillomavirus and overall survival after progression of oropharyngeal squamous cell carcinoma. J Clin Oncol. 32(30):3365–73. https://doi.org/10.1200/JCO.2014.55.1937

    Article  PubMed  PubMed Central  Google Scholar 

  39. Jayaram SC, Muzaffar SJ, Ahmed I, Dhanda J, Paleri V, Mehanna H (2016) Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: a systematic review and meta-analysis. Head Neck. 38(12):1855–1861. https://doi.org/10.1002/hed.24531

    Article  PubMed  Google Scholar 

  40. Meulemans J, Vanclooster C, Vauterin T et al (2017) Up-front and Salvage transoral robotic surgery for head and neck cancer: a Belgian multicenter retrospective case series. Front Oncol. 7:15. https://doi.org/10.3389/fonc.2017.00015

    Article  PubMed  PubMed Central  Google Scholar 

  41. Paleri V, Fox H, Coward S et al (2018) Transoral robotic surgery for residual and recurrent oropharyngeal cancers: exploratory study of surgical innovation using the IDEAL framework for early-phase surgical studies. Head Neck. 40(3):512–525. https://doi.org/10.1002/hed.25032

    Article  PubMed  Google Scholar 

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Funding

This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.

Author information

Author notes

  1. Christian Simon and Stefano Filippo Zorzi are co-last authors.

Authors and Affiliations

  1. Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy

    Mohssen Ansarin, Giacomo Pietrobon, Marta Tagliabue, Chiara Mossinelli & Stefano Filippo Zorzi

  2. Division of Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Francesca Ruju

  3. Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Fausto Maffini

  4. Division of Medical Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Maria Cossu Rocca

  5. Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Daniela Alterio

  6. Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

    Christian Simon

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Correspondence to Giacomo Pietrobon.

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Ansarin, M., Pietrobon, G., Tagliabue, M. et al. Salvage transoral robotic surgery in recurrent oropharyngeal carcinoma: a single-center retrospective study. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08590-4

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