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Functional outcomes after TORS for oropharyngeal cancer: a systematic review

  • Head and Neck
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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.

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Abbreviations

TORS:

Transoral robotic surgery

IMRT:

Intensity-modulated radiotherapy

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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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Authors and Affiliations

  1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1445, Houston, TX, 77030, USA

    Katherine A. Hutcheson, Michael E. Kupferman & Jan S. Lewin

  2. Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford, CA, USA

    F. Christopher Holsinger

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  1. Katherine A. Hutcheson
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  2. F. Christopher Holsinger
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  3. Michael E. Kupferman
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  4. Jan S. Lewin
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Correspondence to Katherine A. Hutcheson.

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Hutcheson, K.A., Holsinger, F.C., Kupferman, M.E. et al. Functional outcomes after TORS for oropharyngeal cancer: a systematic review. Eur Arch Otorhinolaryngol 272, 463–471 (2015). https://doi.org/10.1007/s00405-014-2985-7

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  • DOI: https://doi.org/10.1007/s00405-014-2985-7

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