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Kejner A, Gentile C, Porterfield Z, Carroll WR, Buczek EP. Positive Deep Initial Incision Margin Affects Outcomes in TORS for HPV+ Oropharynx Cancer. Laryngoscope 2023; 133:1132-1137. [PMID: 35809041 PMCID: PMC9826797 DOI: 10.1002/lary.30275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/15/2022] [Accepted: 05/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Evaluate the effect of initial incision margins (IIM) on clinical outcomes after transoral robotic surgery (TORS) for human papillomavirus positive (HPV+) squamous cell cancers of the oropharynx (OPSCC). METHODS Retrospective chart review of patients undergoing TORS for HPV+ OPSCC from 2007 to 2015 was performed. Overall survival (OS), disease-specific survival (DSS), recurrence, and metastases were evaluated in the context of pathology, IIM, final margins, adjuvant therapy, and patient characteristics. RESULTS Ninety-five patients with HPV+ OPSCC undergoing primary surgery were identified. 88% of these patients had no evidence of disease at the conclusion of the study (average follow-up 45 months). Twenty were identified that had true positive IIM and 16 had very close IIM, with the remainder demonstrating widely negative margins. Tumor very close to or involving the deep margin but not a mucosal margin was associated with a higher risk of recurrence. Perineural invasion and lymphovascular invasion were associated with positive IIM. Positive or very close IIM on the deep margin was found to impact DSS and recurrence. CONCLUSION Obtaining negative IIM while performing TORS for HPV+ OPSCC is a modifiable factor that affects recurrence and DSS. Larger surgical margins should be considered in patients with perineural invasion or whose tumor abuts the initial deep margin. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1132-1137, 2023.
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Affiliation(s)
- Alexandra Kejner
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Christopher Gentile
- Department of Otorhinolaryngology, The University of Alabama School of Medicine, Birmingham, Alabama, U.S.A
| | - Zachary Porterfield
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
- Department of Otorhinolaryngology, University of KwaZulu-Natal, Durban, South Africa
| | - William R Carroll
- Department of Otorhinolaryngology, The University of Alabama School of Medicine, Birmingham, Alabama, U.S.A
| | - Erin Partington Buczek
- Department of Otorhinolaryngology, The University of Alabama School of Medicine, Birmingham, Alabama, U.S.A
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2
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Stephen SE, Murphy JM, Beyer FR, Sellstrom D, Paleri V, Patterson JM. Early postoperative functional outcomes following transoral surgery for oropharyngeal cancer: A systematic review. Head Neck 2021; 44:530-547. [PMID: 34882886 DOI: 10.1002/hed.26938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available evidence for validated functional outcomes following TOS for OPC, within the early postoperative period. Key databases were searched. Primary TOS resections of human subjects were included. Validated functional outcomes extracted included instrumental assessment, clinician rated, and patient reported measures. Database searches yielded 7186 titles between 1990 and December 2020. Full-text articles were obtained for 296 eligible studies, which were screened and a resulting 14 studies, comprising 665 participants were included in the review. Oropharyngeal dysfunction following TOS was observed across all three categories of outcome measures (OMs) reported and was dependent on pretreatment function, T-classification, and tumor volume. Future investigations should include optimal OMs to be used in the postoperative setting to allow for conclusive comparisons.
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Affiliation(s)
- Sarah E Stephen
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jennifer M Murphy
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Diane Sellstrom
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Joanne M Patterson
- School of Health Sciences, Liverpool Head and Neck Cancer Centre, University of Liverpool, Liverpool, UK
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Struk S, Qassemyar Q, Leymarie N, Honart JF, Alkhashnam H, De Fremicourt K, Conversano A, Schaff JB, Rimareix F, Kolb F, Sarfati B. The ongoing emergence of robotics in plastic and reconstructive surgery. ANN CHIR PLAST ESTH 2018; 63:105-112. [DOI: 10.1016/j.anplas.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/02/2018] [Indexed: 12/25/2022]
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Liu HH, Li LJ, Shi B, Xu CW, Luo E. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci 2017; 9:63-73. [PMID: 28660906 PMCID: PMC5518975 DOI: 10.1038/ijos.2017.24] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
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Affiliation(s)
- Hang-Hang Liu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Long-Jiang Li
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Bin Shi
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Chun-Wei Xu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - En Luo
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
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Albergotti WG, Jordan J, Anthony K, Abberbock S, Wasserman-Wincko T, Kim S, Ferris RL, Duvvuri U. A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 2017; 123:3132-3140. [PMID: 28467606 DOI: 10.1002/cncr.30712] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology compared with chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study was to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS Patients undergoing TORS for OPSCC were enrolled prospectively. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score >2) and was administered on postoperative day (POD) 1, 7, and 30. Patient demographics, weight, pain level, and clinical outcomes were recorded prospectively and focused on time to oral diet, feeding tube placement, and dysphagia-related readmissions. RESULTS A total of 51 patients were included with pathologic T stages of T1 (n = 24), T2 (n = 20), T3 (n = 3), and Tx (n = 4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD 1 was lower than on POD 7 (21.5 vs 26.6; P = .005) but decreased by POD 30 (26.1 to 12.2; P < .001). Forty-seven (92.1%) patients were discharged on an oral diet, but 57.4% required compensatory strategies or modification of liquid consistency. Ninety-eight percent of patients were taking an oral diet by POD 30. There were no dysphagia-related readmissions. CONCLUSION This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month postoperatively, but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions. Cancer 2017;123:3132-40. © 2017 American Cancer Society.
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Affiliation(s)
- William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jessica Jordan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keely Anthony
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shira Abberbock
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
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Hobelmann K, Luginbuhl A, Bar-Ad V, Keane W, Curry J, Cognetti D. Positron emission tomography/computed tomography after primary transoral robotic surgery for oropharyngeal squamous cell carcinoma. Laryngoscope 2017; 127:2050-2056. [PMID: 28272799 DOI: 10.1002/lary.26515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the first post-treatment positron emission tomography/computed tomography (PET/CT) in prediction of disease-free survival after primary transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) with or without adjuvant chemoradiation. STUDY DESIGN Retrospective review. METHODS Ninety-five patients with OPSCC treated with primary TORS from 2010 to 2014 at a single tertiary academic center were evaluated with PET/CT. Imaging was performed between 2 and 7 months after completing all treatment. Radiology findings were categorized as 1) negative, noting either complete resolution of foci without evidence of disease or anatomical changes likely attributed to treatment; 2) equivocal, noting equal likelihood of malignancy versus treatment-related changes; or 3) positive, noting either findings concerning for malignancy or new hyperactivity not attributed to treatment-related changes. The median follow-up time was 31 months (range, 23-63 months). Recurrence was defined as biopsy-proven invasive malignancy or clinical suspicion sufficient to initiate treatment occurring within 3 years of the completion of all treatment. RESULTS Of 95 total patients with at least 2 years of follow-up records, 26 had positive post-treatment PET/CT results, with five experiencing actual recurrences. Of 69 patients with negative post-treatment PET/CT results, none experienced recurrences. These results indicate a sensitivity of 100%, specificity of 77%, positive predictive value of 19%, and negative predictive value of 100%. CONCLUSIONS A majority of TORS patients (73%) will have a negative first post-treatment PET/CT. A single negative post-treatment PET/CT is strongly correlated with 2-year disease-free survival in patients treated with primary TORS and may warrant decreased surveillance imaging. LEVEL OF EVIDENCE 4 Laryngoscope, 127:2050-2056, 2017.
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Affiliation(s)
- Kealan Hobelmann
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Voichita Bar-Ad
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - William Keane
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - David Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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7
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Tassone P, Crawley M, Bovenzi C, Zhan T, Keane W, Cognetti D, Luginbuhl A, Curry J. Pathologic Markers in Surgically Treated HPV-Associated Oropharyngeal Cancer: Retrospective Study, Systematic Review, and Meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:365-374. [PMID: 28397563 DOI: 10.1177/0003489417693014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Human papillomavirus-associated (HPV) oropharyngeal cancer is a unique clinical entity whose incidence is increasing. It is controversial whether traditional pathologic markers of aggressive head and neck cancer also apply in surgically treated HPV-associated disease. STUDY DESIGN Retrospective study, systematic review, and meta-analysis Data Sources: PubMed and Cochrane review. REVIEW METHODS PubMed and Cochrane review were searched for published articles on surgically treated HPV-associated oropharyngeal cancer. Eligible studies were included in a meta-analysis of survival using several clinicopathologic markers as predictors. Surgically treated HPV-positive oropharyngeal cancer patients at our institution were studied retrospectively and added to the meta-analysis. RESULTS Eight published reports, plus our retrospective series, were included in the meta-analysis. This showed significant impact on event-free survival for T stage, nodal number, perineural invasion, and lymphovascular invasion (all P < .05) but not for N stage extracapsular extension ( P = ns). CONCLUSIONS While many traditional clinico-pathologic markers of aggressive disease in head and neck cancer also impact survival in surgically treated HPV-associated oropharyngeal cancer, extracapsular extension may be less important.
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Affiliation(s)
- Patrick Tassone
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meghan Crawley
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Cory Bovenzi
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- 2 Department of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William Keane
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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8
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Tongue base exposure during TORS without the use of a mouth prop. J Robot Surg 2016; 10:347-352. [PMID: 27324238 DOI: 10.1007/s11701-016-0609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
This study describes a novel exposure technique for base of tongue trans-oral robotic surgery (BOT TORS) and early experience with it. The technique discussed involves placement of a suture through the mobile tongue with distraction and suspension of the tongue to the operating table. TORS is then performed per previously described techniques. In our series, 13 patients with either benign or malignant mass lesions involving the tongue base were treated with TORS at a tertiary academic medical center. We reviewed the rates of adequate exposure, console time, adequacy of resection (in malignant cases), complication rates, and costs associated with this technique. In our series, adequate exposure was achieved in 92.3 % of patients. Mean console time was 36 min. Negative surgical margins were achieved in all cancer resections. Five minor complications (tongue lacerations) were observed. Per-case cost attributable to this technique is $3.81. We conclude that BOT TORS is feasible without the use of a mouth prop. Operative times are consistent with those reported by centers that routinely use mouth props for BOT TORS. This technique does not appear to compromise margin adequacy during oncologic resections. Its use may result in a significant cost savings when compared to the FK and other similar retractors.
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9
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O'Leary P, Kjærgaard T. Transoral robotic surgery and oropharyngeal cancer: a literature review. EAR, NOSE & THROAT JOURNAL 2016; 93:E14-21. [PMID: 25181669 DOI: 10.1177/014556131409300821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of head and neck squamous cell carcinoma has risen steadily over the past decade due to the increase in cancers associated with the human papillomavirus (HPV). The prognosis for the treatment of this type of cancer with radiotherapy and chemoradiotherapy is good. However, because these treatments can have detrimental effects on organ function and quality of life, researchers are looking into transoral robotic surgery (TORS) as a possible alternate therapy. TORS might have a positive effect on postoperative function and quality of life for cancer survivors. The aim of this review is to report on the current situation regarding the treatment of oropharyngeal cancer with TORS, with a focus on the long-term oncologic and functional outcomes of this strategy. The articles cited in this review were selected from the PubMed and MEDLINE database. They contain study results pertaining to TORS implementation, complications, oncologic and functional outcomes, and the implications of HPV-associated cancer. We found that while TORS has some clear advantages and strengths and almost certainly a permanent place in future treatment, further research is necessary to correctly evaluate the role it will play in the complete management of oropharyngeal cancer.
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Affiliation(s)
- Pádraig O'Leary
- Department of Otorhinolaryngology-Head and Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, Byg. 10, 1. Sal., 8000 Aarhus C, Denmark.
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10
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Thottam PJ, Govil N, Duvvuri U, Mehta D. Transoral robotic surgery for sleep apnea in children: Is it effective? Int J Pediatr Otorhinolaryngol 2015; 79:2234-7. [PMID: 26518466 DOI: 10.1016/j.ijporl.2015.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Children with obstructive sleep apnea/hypopnea syndrome (OSAHS) as a result of base of tongue (BOT) or lingual tonsillar hypertrophy do not improve following adenotonsillectomy. In adults, transoral robotic surgery (TORS) offers a means of treating such patients, however the efficacy of this technique for children is not known. In this study, we examine the effectiveness of TORS BOT reduction and lingual tonsillectomy for treatment of pediatric OSAHS. METHODS This was a retrospective study of nine patients (5 non-syndromic; 4 syndromic) who underwent isolated BOT reduction and lingual tonsillectomy for OSAHS between 2012 and 2014 at a tertiary care pediatric medical center. Differences between pre and post surgical polysomnograms (PSGs) were utilized to measure the procedural effectiveness. Patient age, sex, body mass index (BMI), developmental status, and comorbid conditions were also examined. RESULTS The average patient age was 10.5 years (range 5.2-18.5). There were 5 males and 4 females. The mean pre-operative obstructive AHI (O-AHI) was 27.1 compared to 10.9 post-operatively (mean difference=16.1, t=2.27, p≤0.05). Statistically significant reductions were also noted in hypopneic events (mean difference=61.3, t=2.64, p<0.05) and lowest oxygen saturation (mean difference=9.0, t=-3.29, p≤0.01). One patient developed a post-operative bleed that was controlled operatively. CONCLUSIONS In children with airway obstruction associated with BOT and lingual tonsillar hypertrophy, TORS is a useful and effective tool. Patients' who underwent TORS demonstrated a significant decrease in obstructive events. All patients reviewed exhibited at least a 50% reduction in O-AHI.
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Affiliation(s)
- Prasad John Thottam
- Children's Hospital of Pittsburgh of UPMC, Pediatric Otolaryngology, 4401 Penn Ave, Pittsburgh, PA 15224, USA; Michigan Pediatric Ear, Nose and Throat Associates, 29120 Franklin Rd, Southfield, MI 48034, USA; Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St, Detroit, MI 48201, USA.
| | - Nandini Govil
- University of Pittsburgh Medical Center, Otolaryngology, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - Umamaheswar Duvvuri
- University of Pittsburgh Medical Center, Otolaryngology, 200 Lothrop St, Pittsburgh, PA 15213, USA; Department of Otolaryngology, Department of Veterans Affairs Pittsburgh Health System, University Drive, Pittsburgh, PA 15240, USA
| | - Deepak Mehta
- Children's Hospital of Pittsburgh of UPMC, Pediatric Otolaryngology, 4401 Penn Ave, Pittsburgh, PA 15224, USA; University of Pittsburgh Medical Center, Otolaryngology, 200 Lothrop St, Pittsburgh, PA 15213, USA; Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA
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11
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Diavolitsis V, Quon H. Treatment De-intensification in HPV-Associated Oropharyngeal Cancer: Evidence, Controversies, and Strategies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Chung TK, Rosenthal EL, Magnuson JS, Carroll WR. Transoral robotic surgery for oropharyngeal and tongue cancer in the United States. Laryngoscope 2014; 125:140-5. [PMID: 25093603 DOI: 10.1002/lary.24870] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/25/2014] [Accepted: 07/14/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009. STUDY DESIGN Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011. METHODS Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code. RESULTS TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P < 0.001), higher charge ($98,228 vs. $67,317, P < 0.001), higher cost ($29,365 vs. $20,706, P < 0.001), higher rates of tracheostomy and gastrostomy tube placement, and more wound and bleeding complications. TORS was associated with a higher rate of dysphagia (19.5% vs. 8.0%, P < 0.001). The lower cost of TORS remained significant in the major-to-extreme severity of illness group but was associated with higher complication rates when compared to open cases of the same severity of illness. A similar analysis of TORS partial glossectomy for base of tongue tumors had similar cost and length of stay benefits, whereas TORS partial glossectomy for anterior tongue tumors revealed longer hospital stays and no benefit in charge or cost compared to open. CONCLUSIONS Early data demonstrate a clinical and cost benefit in TORS partial pharyngectomy and partial glossectomy for the base of tongue but no benefit in partial glossectomy of the anterior tongue. It is likely that anatomic accessibility and extent of surgery factor into the effectiveness of TORS.
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Affiliation(s)
- Thomas K Chung
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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13
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Luginbuhl A, Baker A, Curry J, Drejet S, Miller M, Cognetti D. Preoperative cephalometric analysis to predict transoral robotic surgery exposure. J Robot Surg 2014; 8:313-7. [PMID: 25419245 PMCID: PMC4236604 DOI: 10.1007/s11701-014-0471-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
Transoral robotic surgery (TORS) is being increasingly used in the treatment of head and neck cancer and we wanted to determine the feasibility of predicting TORS access using cephalometric measurements obtained from preoperative imaging. 20 cephalometric measurements were obtained from imaging on 31 TORS base of tongue (BOT) resections and compared to adequacy of exposure. Three measurements were found to be significantly different between the restricted and adequate exposure groups. Distances from posterior pharyngeal wall (PPW) to hyoid, PPW to soft palate and epiglottis to vertical laryngeal angle were all statistically different between the two groups. Receiver operating characteristic (ROC) analysis revealed strong correlation to exposure for all three measurements with cut offs ≤30 mm between the PPW and the hyoid, ≤8.1 mm PPW and soft palate and ≥130° between the epiglottis and vertical plain of the larynx all representing restricted exposure. Duration of surgery for the restricted group, 85 min, was significantly longer than the adequate exposure group, 51 min (p = 0.026). Preoperative measurements of radiographic images of the oropharyngeal working space can predict restricted exposure for TORS resection of the BOT. These measures may be used in conjunction with other subjective assessment parameters to predict which patients could benefit from a staging endoscopy to determine adequate TORS exposure.
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Affiliation(s)
- Adam Luginbuhl
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Adam Baker
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Joseph Curry
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Sarah Drejet
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
| | - Matthew Miller
- Department of Otolaryngology Head and Neck Surgery, University of Rochester, Rochester, NY USA
| | - David Cognetti
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St, 6th Floor, Philadelphia, PA 19107 USA
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14
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Richmon JD, Feng AL, Yang W, Starmer H, Quon H, Gourin CG. Feasibility of rapid discharge after transoral robotic surgery of the oropharynx. Laryngoscope 2014; 124:2518-25. [DOI: 10.1002/lary.24748] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/03/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Jeremy D. Richmon
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Allen L. Feng
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Wuyang Yang
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
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Robotic Surgery for Salivary Gland Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades mostly due to human papillomavirus (HPV)-related infections. Cancers resulting from HPV infection bear a better prognosis than those that are smoking-related. Because HPV-positive patients are often younger, with lower rates of co-morbid illness and longer overall life expectancies, long-term sequelae of therapy have become an important issue. Treatment of oropharyngeal cancers has typically involved the use of radiation and chemotherapy to avoid the morbidity of open surgery which included mandibulotomy and composite resection. Transoral robotic surgery (TORS) is an emerging treatment option for this disease, avoiding the morbidity of open approaches while providing excellent oncologic and functional outcomes. With overall survival rate at 2 years exceeding 80%, and local failure rate of less than 3%, patients receiving TORS report relatively good health-related quality of life (QOL) scores. The aim of the current review is to provide a summary of the current literature with regard to the oncologic and functional outcomes following treatment of OPSCC with TORS.
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Affiliation(s)
- Irit Duek
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Salem Billan
- The Oncology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Laboratory for Applied Cancer Research, the Clinical Research Institute, Rambam Health Care Campus, The Technion, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Laboratory for Applied Cancer Research, the Clinical Research Institute, Rambam Health Care Campus, The Technion, Haifa, Israel
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