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Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins
Gregory S Weinstein1, Bert W O'Malley, J Scott Magnuson
1Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Objectives/Hypothesis:
Our objective was to determine the safety, feasibility, and the adequacy of surgical margins for transoral robotic surgery (TORS), by reviewing the early results from independent institutional review board-approved clinical trials in three separate institutions.
Study Design:
Pooled Data from Independent Prospective Clinical Trials.
Methods:
One hundred ninety-two patients were initially screened, but inadequate exposure did not permit TORS in 13 (6.7%). For two additional patients, TORS was begun but intraoperatively converted to an open procedure. Thus, the intent-to-treat population was 177 patients (average age, 59 years; 81% male), predominantly comprised of tumors arising in the oropharynx (139, 78%) and larynx (26, 15%). TORS was performed for 161 (91%) patients with malignant disease: 153 (95%) with squamous cell carcinoma (T1 [50, 32.7%], T2 [74, 48.4%], T3 [21, 13.7%], T4 [8, 5.2%]), six patients (3.72%) with salivary gland tumors, and two patients with carcinoma in situ. The average follow-up was 345 days.
Results:
There was no intraoperative mortality or death in the immediate postoperative period. Average estimated blood loss was 83 mL; no patient required transfusion. The rate of positive margins was 4.3%. Twenty-nine patients (16%) experienced 34 serious adverse events that required hospitalization or intervention (grade 3) or were considered life threatening (grade 4, 2.3%). Tracheostomy was performed in 12.4% of all patients (22/177), but only 2.3% had a tracheostomy at last follow-up. For all patients undergoing TORS without previous therapy, the percutaneous endoscopic gastrostomy dependency rate was 5.0%. The average hospital stay was 4.2 days.
Conclusions:
Based on this multicenter study, TORS appears to be safe, feasible, and as such play an important role in the multidisciplinary management of head and neck cancer.
Insights
Transoral robotic surgery (TORS) is a safe and feasible option for head and neck cancer management. This multicenter study shows TORS offers adequate surgical margins with acceptable complication rates.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Robotic Surgery
Background:
- Transoral robotic surgery (TORS) is an evolving minimally invasive technique for head and neck cancers.
- Assessing the safety, feasibility, and oncologic outcomes of TORS is crucial for its wider adoption.
Purpose of the Study:
- To evaluate the safety, feasibility, and surgical margin adequacy of TORS.
- To review early outcomes from independent, IRB-approved clinical trials across three institutions.
Main Methods:
- Pooled data analysis from prospective clinical trials involving 177 patients.
- Focus on oropharyngeal and laryngeal tumors, predominantly squamous cell carcinoma.
- Average follow-up of 345 days.
Main Results:
- No intraoperative or immediate postoperative mortality.
- Low positive margin rate (4.3%) and minimal blood loss (average 83 mL).
- 16% experienced serious adverse events; 12.4% required temporary tracheostomy.
Conclusions:
- TORS demonstrates safety and feasibility in head and neck cancer treatment.
- It plays a significant role in the multidisciplinary management of these cancers.
- Adequate surgical margins are achievable with TORS.
