scholarly journals Utility of up-front transoral robotic surgery in tailoring adjuvant therapy

Head & Neck ◽  
2016 ◽  
Vol 38 (8) ◽  
pp. 1201-1207 ◽  
Author(s):  
Neil Gildener-Leapman ◽  
Jeehong Kim ◽  
Shira Abberbock ◽  
Garret W. Choby ◽  
Rajarsi Mandal ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Adjuvant Therapy ◽  
Transoral Robotic Surgery

Transoral robotic surgery and adjuvant therapy for oropharyngeal carcinomas and the influence of p16INK4a on treatment outcomes

2013 ◽  
Vol 123 (3) ◽  
pp. 635-640 ◽  
Author(s):  
Harry Quon ◽  
Marc A. Cohen ◽  
Kathleen T. Montone ◽  
Amy F. Ziober ◽  
Li Ping Wang ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Adjuvant Therapy ◽  
Treatment Outcomes ◽  
Transoral Robotic Surgery

scholarly journals Gastrostomy Tube Use after Transoral Robotic Surgery for Oropharyngeal Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Samer Al-khudari ◽  
Scott Bendix ◽  
Jamie Lindholm ◽  
Erin Simmerman ◽  
Francis Hall ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Adjuvant Therapy ◽  
Free Flap ◽  
Salvage Therapy ◽  
Transoral Robotic Surgery ◽  
Gastrostomy Tube ◽  
First Year ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Early Disease

Objective. To evaluate factors that influence gastrostomy tube (g-tube) use after transoral robotic surgery (TORS) for oropharyngeal (OP) cancer. Study Design/Methods. Retrospective review of TORS patients with OP cancer. G-tube presence was recorded before and after surgery at followup. Kaplan-Meier and Cox hazards model evaluated effects of early (T1 and T2) and advanced (T3, T4) disease, adjuvant therapy, and free flap reconstruction on g-tube use. Results. Sixteen patients had tonsillar cancer and 13 tongue base cancer. Of 22 patients who underwent TORS as primary therapy, 17 had T1 T2 stage and five T3 T4 stage. Seven underwent salvage therapy (four T1 T2 and three T3 T4). Nine underwent robotic-assisted inset free flap reconstruction. Seventeen received adjuvant therapy. Four groups were compared: primary early disease (PED) T1 and T2 tumors, primary early disease with adjunctive therapy (PEDAT), primary advanced disease (PAD) T3 and T4 tumors, and salvage therapy. Within the first year of treatment, 0% PED, 44% PEDAT, 40% PAD, and 57% salvage patients required a g-tube. Fourteen patients had a temporary nasoenteric tube (48.3%) postoperatively, and 10 required a g-tube (34.5%) within the first year. Four of 22 (18.2%) with TORS as primary treatment were g-tube dependent at one year and had received adjuvant therapy. Conclusion. PED can be managed without a g-tube after TORS. Similar feeding tube rates were found for PEDAT and PAD patients. Salvage patients have a high rate of g-tube need after TORS.

Outcomes and prediction of lethal recurrence after transoral robotic surgery for HPV+ head and neck cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6047-6047
Author(s):  
Devraj Basu ◽  
David Shimunov ◽  
Roger B. Cohen ◽  
Alexander Lin ◽  
Samuel Swisher-McClure ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Adjuvant Therapy ◽  
Head And Neck ◽  
Risk Model ◽  
Transoral Robotic Surgery ◽  
Whole Body ◽  
Free Survival ◽  
Positive Margins ◽  
Recurrence Patterns

6047 Background: Increasing use of transoral robotic surgery (TORS) for human papilloma virus-related (HPV+) head and neck squamous cell carcinomas (HNSCCs) is likely to impact recurrence patterns and outcomes. Profiling HPV+ HNSCC recurrences after TORS and identifying features predictive of lethal outcome would facilitate tailoring adjuvant therapy and guide surveillance post-therapy. This study uses long term follow-up of patients at the first institution to bring TORS into clinical use to describe the recurrence patterns, distinguish outcomes associated with distinct patterns, and create a risk model for lethal recurrence. Methods: This retrospective cohort study at a single academic tertiary center analyzed 634 consecutive, treatment-naïve HPV+ HNSCC patients receiving TORS and neck dissection for clinical features at presentation and pathologic traits identified by surgical resection. The main outcomes were distant metastatic recurrence (DMR) and locoregional recurrence (LRR). Multivariate logistic regression with backward stepwise elimination was used to identify features associated with recurrence. Results: 6.5% of patients developed DMR at a median of 12.4 months after surgery and had a 5-year overall survival (OS) of 52.5% (95% CI, 33.9%-68.2%), whereas the 6.2% patients developing LRR alone had 5-year OS of 83.3% (95% CI, 66.2%-92.2%; P =.01). After recurrence, 5-year progression-free survival was 24.7% (95% CI, 11.4%-40.7%) for DMR cases and 85.7% (95% CI, 65.1-94.6%) for cases with LRR alone (P <.001). Comparing recurrent cases to recurrence-free controls showed DMR to be independently associated with positive surgical margins (AOR 5.7; 95% CI, 2.1-15.7) and advanced clinical stage at presentation (AOR 6.5; 95% CI, 1.9-23.0). Positive margins increased DMR risk by 4.2-fold and reduced 5-year disease-free survival (P <.001) in early-stage cases (Table), which comprised 95% of the cohort. By contrast, isolated LRR was associated with failure to receive indicated adjuvant therapy and was usually controllable by salvage therapy. Conclusions: Based on the largest single institution cohort reported to date, long term oncologic outcomes for HPV+ HNSCCs after TORS are excellent overall. While DMR is often fatal, LRR is salvageable with durable disease control. In addition to standard staging criteria, positive margins indicate substantially higher risk of DMR but not LRR. A risk model for DMR that incorporates margin status after TORS is relevant for guiding clinical trial design and whole-body surveillance.[Table: see text]

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