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Costantino A, Meliante PG, Sampieri C, Lee K, Ralli M, De Vincentiis M, De Virgilio A, Kim SH. Neoadjuvant chemotherapy and transoral robotic surgery for the posterior pharyngeal wall carcinoma. Eur Arch Otorhinolaryngol 2023; 280:4649-4655. [PMID: 37395758 DOI: 10.1007/s00405-023-08070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The squamous cell carcinoma (SCC) of the posterior pharyngeal wall (PPW) is associated with poor oncological outcomes based on current literature data. We reported the preliminary outcomes of a potential new treatment protocol based on neoadjuvant chemotherapy (NCT) and transoral robotic surgery (TORS). METHODS A retrospective single-center case series was performed including a total of 20 patients diagnosed with a SCC of the PPW between October 2010 and September 2021. All patients successfully completed TORS with neck dissection after NCT. Adjuvant treatment was performed in the presence of adverse pathologic features. Loco-regional control (LRC), overall survival (OS), and disease-specific survival (DSS) were defined as the time from surgery to tumor recurrence or death, as appropriate. Survival estimates were calculated by Kaplan-Meier analysis. Surgical data and post-operative functional outcomes were also reported. RESULTS Estimated 3-year LRC, OS, and DSS rates (95% Confidence interval) were 59.7% (39.7-89.6), 58.6% (38.7-88.8), and 69.4% (49.9-96.6). The median hospital stay was 21 days (IQR 17.0-23.5). Oral diet and decannulation were achieved after a median of 14 days (IQR 12.0-15.0). Feeding tube and tracheostomy dependence after 6 months was observed in 3 (15%) and 2 (10%) patients, respectively. CONCLUSIONS The use of NCT followed by TORS for PPW SCC treatment appears to have good oncological and functional outcomes for both early and locally advanced cancers. Further randomized trials and site-specific guidelines are needed.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Piero Giuseppe Meliante
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, RM, Italy
| | - Claudio Sampieri
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Kyuin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, RM, Italy
| | - Marco De Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, RM, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Lallemant B, Moriniere S, Ceruse P, Lebalch M, Aubry K, Hans S, Dolivet G, Malard O, Bonduelle Q, Vergez S. Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall. Eur Arch Otorhinolaryngol 2017; 274:4211-4216. [PMID: 29032418 DOI: 10.1007/s00405-017-4771-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan-Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi2 test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.
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Affiliation(s)
- B Lallemant
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France.
| | - S Moriniere
- Department of Head and Neck Surgery, University Hospital Bretonneau, Tours, France
| | - P Ceruse
- Department of Head and Neck Surgery, Hospices Civils de Lyon, University Hospital Lyon-Nord, Lyon, France
| | - M Lebalch
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France
| | - K Aubry
- Department of Head and Neck Surgery, University Hospital Dupuytren, Limoges, France
| | - S Hans
- Department of Head and Neck Surgery, AP-HP, Georges Pompidou Hospital, Paris, France
| | - G Dolivet
- Department of Head and Neck Surgery, Centre Alexis Vautrin, Nancy, France
| | - O Malard
- Department of Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Q Bonduelle
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France
| | - S Vergez
- Department of Head and Neck Surgery, University Hospital Larrey, Toulouse, France
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