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Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status

  • Head and Neck
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Abstract

There is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) in the western world due to human papillomavirus (HPV). According to the Danish Head and Neck Cancer Group guidelines, the current recommended treatment of patients with OPSCC in Denmark is primary radiation therapy (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September 2014 and January 2016, 30 consecutive patients with clinical T1–T2, N0–N1 OPSCC underwent primary TORS and concurrent neck dissection. The patients were offered postoperative adjuvant therapy according to pathological risk parameters: pT >2, T-site margin <2 mm, pN >1 or extracapsular extension (ECE). Concomitant chemotherapy was offered to patients with the presence of ECE or involved margins. Twenty-nine patients had negative margins on T-site after primary resection. Only one patient had a close margin of 1 mm. Unilateral neck dissection was performed in 21 patients while nine patients underwent bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may be an alternative to primary RT and CCR in a selected group of patients with early stage OPSCC.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Niclas Rubek, Hani Ibrahim Channir, Birgitte Wittenborg Charabi, Christel Bræmer Lajer, Hans Ulrik Nielsen & Christian von Buchwald

  2. Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Katalin Kiss

  3. Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark

    Jens Bentzen

  4. Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Jeppe Friborg

Authors
  1. Niclas Rubek
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  2. Hani Ibrahim Channir
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  3. Birgitte Wittenborg Charabi
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  4. Christel Bræmer Lajer
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  5. Katalin Kiss
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  6. Hans Ulrik Nielsen
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  7. Jens Bentzen
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  8. Jeppe Friborg
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  9. Christian von Buchwald
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Correspondence to Niclas Rubek.

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Financial disclosures

The Da Vinci SI HD robot was obtained through a grant from The Candys Foundation, a non-profit foundation. HIC salary in PhD project was also funded by The Candys Foundation.

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The authors declare that they have no conflict of interest.

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Rubek, N., Channir, H.I., Charabi, B.W. et al. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. Eur Arch Otorhinolaryngol 274, 2229–2237 (2017). https://doi.org/10.1007/s00405-016-4433-3

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  • DOI: https://doi.org/10.1007/s00405-016-4433-3

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