Neoadjuvant chemotherapy combined with transoral robotic surgery for stage III and IV laryngeal and hypopharyngeal carcinomas

Efficacy of Vascular Ligation for the Prevention of Intra- and Postoperative Bleeding in Transoral Robotic Surgery for Oropharyngeal Cancer

BACKGROUND

Transoral robotic surgery (TORS) is a minimally invasive procedure that is performed with neck dissection (ND) and postoperative radiotherapy when necessary. This study aimed to review the methods of vascular ligation and ND in cases of TORS for oropharyngeal cancer in Japan.

METHODS

We enrolled 44 consecutive patients who underwent TORS for laryngopharyngeal cancer between December 2019 and December 2023. Of these, 35 patients who underwent TORS as a first-line treatment for oropharyngeal cancer were included in this study. We retrospectively collected patient data on age, sex, primary tumor location, clinical tumor-node classification, Eastern Cooperative Oncology Group performance status, history of irradiation to the neck, presence of anticoagulants, pathological results, tumor size, total operative duration, console time, length of skin incision operative result, estimated blood loss, late cervical lymph node metastasis, perioperative complications, postoperative hospital stay, postoperative bleeding, period until oral intake after surgery, and swallowing function. Intra- and postoperative outcomes of TORS, TORS + ND (IIa) + vascular ligation, and TORS + ND (II-IV) + vascular ligation.

RESULTS

Significant differences were found in operative duration, blood loss during ND, and skin incision length between TORS + ND (IIa) + vascular ligation and TORS + ND (II-IV) + vascular ligation. Console time and blood loss did not significantly differ between the two groups. Each group contained one case of postoperative bleeding.

CONCLUSIONS

Safe and minimally invasive treatments can be established if vascular ligation and ND are implemented based on appropriate case selection.

Application of pedicled supraclavicular flaps in hypopharyngectomy with preservation of laryngeal function

OBJECTIVE

To evaluate the efficacy of pedicled supraclavicular flaps in hypopharyngectomy reconstruction, with a focus on preserving laryngeal function.

METHODS

From August 2019 to June 2022, 14 patients with primary hypopharyngeal carcinoma who met the inclusion and exclusion criteria and underwent the repair of hypopharyngeal defects using pedicled supraclavicular flaps were included retrospectively. Relevant clinical evaluation indicators include patient characteristics, defect sizes, flap sizes, flap harvesting time, postoperative hospital stay, postoperative complications, recurrence, and survival outcomes.

RESULTS

Among the 14 patients, pyriform sinus carcinoma (n = 10) and posterior hypopharyngeal wall carcinoma (n = 4) were present, with stages T2 (n = 7), T3 (n = 4), T4 (n = 3), N0 (n = 3), N1 (n = 1), and N2 (n = 10). The average defect size was 7.0 (4.0-12.6) cm in the longitudinal diameter and 4.1 (2.8-7.5) cm in the transverse diameter. The mean flap size was 8.4 (5.0-14.0) cm in length and 6.5 (4.0-9.0) cm in width. The mean time for flap harvesting was 37.0 (29.0-51.0) min. The mean postoperative hospital stay was 24.0 (12.0-48.0) days. The mean follow-up period was 20.3 (4.0-47.0) months, and one of the 14 patients was lost during follow-up. Short-term postoperative complications included partial flap necrosis (n = 1), subcutaneous hematoma at the donor site (n = 1), and pharyngeal fistula (n = 4). Long-term complications encompassed pharyngoesophageal anastomotic stenosis (n = 2) and shoulder elevation dysfunction (n = 2). Tumor recurrence occurred in 3 patients. 1 patient succumbed to massive hemorrhage resulting from neck infection due to pharyngeal fistula during chemoradiotherapy. 2 patients succumbed to tumor-related causes. The gastric tube was removed in 13 patients, and the tracheal tube was extracted in 10 patients.

CONCLUSION

The supraclavicular flap offers a promising alternative for reconstruction during hypopharyngectomy with preservation of laryngeal function. It can be utilized to reshape the morphology of the pyriform fossa, aryepiglottic wall, and laryngeal cavity, thereby restoring the functionality of the laryngopharynx.

Surgical, Functional, and oncological outcomes of transoral robotic surgery for cT1-T3 supraglottic laryngeal Cancers: A systematic review

BACKGROUND

This systematic review investigated the surgical, functional, and oncological outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL) for cT1-T3 laryngeal squamous cell carcinoma (LSCC).

METHODS

Two investigators conducted an updated PubMed, Scopus, and Cochrane Library systematic review for studies investigating the surgical, functional, and oncological outcomes of TORS-SGL using the PRISMA statements. The bias analysis was conducted with the MINORS.

RESULTS

Twenty-one studies were included, accounting for 896 patients. TORS-SGL was primarily performed for cT1 (39.1 %), cT2 (46.9 %), and some selected cT3 (7.7 %) LSCCs. Surgical margins were positive in 10.8 % of cases. The mean hospital stay was 8.6 days. Hemorrhage (6.3 %), pneumonia (5.5 %), and aspiration (1.7 %) are the primary complications. The surgical margins were positive in 10.6 % of cases. Feeding tubes, temporary tracheotomy, and definitive percutaneous gastrostomy are found in 65.6 %, 19.7 %, and 5.2 % of patients, respectively. The oral diet is restarted after a mean of 7.2 days. The 5-year OS and DFS of TORS-SGL were estimated to be 78.3 %, and 91.7 %, with 5-year local-relapse-free survival and nodal-relapse-free survival of 90.8 %, and 86.6 %, respectively.

CONCLUSION

The TORS-SGL is a safe, and effective surgical approach for cT1-T3 SGL. The functional and surgical outcomes appear comparable with TOLM-SGL. The oncological outcomes of TORS-SGL could be better than TOLM and open SGLs, but further large cohort-controlled studies are needed to draw reliable conclusions.

Survival, Surgical, and functional outcomes of transoral laser microsurgery for cT1-T3 supraglottic laryngeal Cancers: A systematic review

BACKGROUND

This review aimed to investigate the surgical, functional, and oncological outcomes of transoral laser microsurgery supraglottic laryngectomy (TOLM-SGL) for cT1-T3 laryngeal cancers.

METHODS

PubMed, Scopus, and Cochrane Library were searched by two independent investigators for studies investigating the surgical, functional, and oncological outcomes of TOLM-SGL using the PRISMA statements. A bias analysis was carried out with MINORS.

RESULTS

Twenty-four studies were included (937 patients), including 206 (25.9 %) cT1, 467 (58.7 %) cT2, and 123 (15.4 %) cT3 cases. Most patients were cN0 (63.9 %). The mean hospital stay of TOLM was 10.1 days. Aspiration (5.5 %), and bleeding (5.3 %) were the most prevalent complications. The laryngeal preservation rate was 93.7 %. Temporary tracheotomy was performed in 18.0 % of patients, with a mean time of decannulation of 6.8 days. A feeding tube was placed in 59.9 % of patients. The oral diet restarted after 6.4 days. Definitive gastrostomy was necessary in 2.4 % of cases. The 5-year OS and DFS were 70.1 % and 82.0 %, respectively. Distant metastasis, local, and regional recurrence occurred in 4.6 %, 11.6 %, and 5.1 % of patients. There was an important heterogeneity between studies for inclusion criteria, patient profiles, TOLM indications, and details of surgical, functional, and oncological outcomes.

CONCLUSION

TOLM supraglottic laryngectomy is a safe, and effective procedure associated with adequate functional, surgical, and oncological outcomes. Future studies are needed to define the place of TOLM in advanced LSCC; the role and timing of concomitant bilateral neck dissection, the indications of tracheotomy and feeding tube.

Induction chemotherapy followed by transoral laser microsurgery with or without adjuvant therapy for advanced hypopharyngeal cancer patients: A preliminary result

BACKGROUND

Hypopharyngeal squamous cell carcinoma (HPSCC) has the poorest prognosis among head and neck cancers. Its treatment may significantly affect breathing, speaking, and swallowing. Induction chemotherapy (ICT) followed by transoral laser microsurgery (TLM) could reduce these adverse effects and achieve good outcomes.

METHODS

This was a retrospective study of 11 patients with advanced HPSCC. All patients underwent ICT and TLM alongside tailor-made adjuvant therapy based on the pathological features.

RESULTS

Adjuvant therapy was done in seven of 11 patients (64%). The 3-year disease-free survival and laryngeal preservation rates were 78% and 91%, respectively. At the last follow-up, 10 of 11 patients (91%) had no tracheostomy or feeding tube.

CONCLUSION

ICT followed by TLM is an appropriate treatment for good tumor control in select patients with advanced HPSCC while preserving laryngeal function.

Robotic Surgery for Head and Neck Tumors: What are the Current Applications?

BACKGROUND

The journey from radical treatments to the precision of robotic surgery underscores a commitment to innovation and patient-centered care in the field of head and neck oncology.

PURPOSE OF REVIEW

This article provides a comprehensive overview that not only informs but also stimulates ongoing discourse and investigation into the optimization of patient care through robotic surgery. The literature on current robotic applications within head and neck region was systematically reviewed.

RECENT FINDINGS

Thirty-four studies with a total of 1835 patients undergoing robotic surgery in head and neck region were included. Clinical staging, histological types, operative duration, postoperative complications, functional recovery and survival outcomes were compared and evaluated. Clinical outcomes have shown promising results and thus the indication on the robotic usage has no longer been limited to oropharyngeal region but from skull base to neck dissection. The latest advancement in robotic surgery further refines the capabilities of surgeons into previously difficult-to-access head and neck regions and heralds a new era of surgical treatment for head and neck oncology.

Neoadjuvant therapy with chemotherapy and immune checkpoint inhibitor for laryngeal function preservation in locally advanced hypopharyngeal cancer

Purpose

To evaluate the efficacy and laryngeal function preservation of neoadjuvant treatment with chemotherapy and immune checkpoint inhibitor for locally advanced hypopharyngeal cancer (LAHPC).

Methods

We retrospectively collected LAHPC patients who were diagnosed between February 2022 and June 2023. The patients received a combination of chemotherapy and immune checkpoint inhibitors as the neoadjuvant therapy. The response to treatment, laryngeal function preservation rate, and short-term survival were assessed.

Results

A total of 20 patients were included. Of these patients, 17 (85.0%) had stage IVA-B disease. Ten (50%) and four (20%) patients achieved pathological complete response (PCR) and major pathological response (MPR) to the primary tumor, respectively. In addition, 6 patients had incomplete pathological response (IPR). In the neck, 19 patients had node-positive disease before treatment, and only 5 patients (26.4%) had PCR to regional lymph nodes. Pathologically positive lymph nodes were still observed in 14 (73.6%) patients. Significant downgrading on narrow-band imaging assessment in primary tumors was associated with a higher probability of PCR or MPR than those with IPR (92.9% vs. 33.3%, P=0.014). The overall rate of laryngeal preservation was 95.0%. No severe perioperative complications or perioperative death were found. All patients completed the recommended postoperative radiotherapy/chemoradiotherapy. The median follow-up period was 12.1 months. The 1-year progression-free survival and overall survival were 94.1% and 92.9%, respectively. During the follow-up period, all 19 patients who underwent laryngeal preservation surgery had their laryngeal function preserved.

Conclusion

The addition of an immune checkpoint inhibitor to neoadjuvant chemotherapy effectively preserves laryngeal function without increasing complications related to surgery and postoperative radiotherapy in LAHPC.

Neo-adjuvant chemotherapy and transoral robotic surgery in locoregionally advanced oropharyngeal cancer

PURPOSE

To analyze the oncological outcomes and patterns of recurrence of patients with locoregionally advanced oropharyngeal squamous cell carcinoma (OPSCC) who underwent neo-adjuvant chemotherapy (NCT) with subsequent transoral robotic surgery (TORS).

METHODS

A single-center retrospective cohort study was performed, including 198 patients (mean age: 58.6, SD: 9.2). The primary outcome was disease-free survival (DFS).

RESULTS

The median follow-up time was 26.5 months (IQR: 16.0-52.0). Estimated DFS rates (95 % CI) at 1 and 3 years were 86.6 % (81.9-91.7), and 81.4 % (75.7-87.6), respectively. Estimated DSS rates (95 % CI) at 1 and 3 years were 96.7 % (94.1-99.3), and 92.6 % (88.4-97.0), respectively. Estimated OS rates (95 % CI) at 1 and 3 years were 96.2 % (93.4-99.0), and 88.7 % (83.4-94.2), respectively. A total of 31 (15.6 %) patients showed a disease relapse after a median time of 8 months (IQR: 4.0-12.0), but only 12 (6 %) patients died of the disease during the study period.

CONCLUSIONS

This study demonstrates that NCT and TORS can obtain excellent tumor control and survival in locoregionally advanced OPSCC. NCT might reduce the need for adjuvant treatments, and randomized clinical trials should be conducted to better define this aspect.