Outcomes after transoral robotic surgery for laryngeal cancer: a database study

Transoral robotic surgery (TORS) for laryngeal cancer was first described in 2007. Since then, relatively small case series have supported the safety and feasibility in humans. We aimed to examine 90-day functional outcomes and complication rates after TORS for laryngeal cancer using a publicly available national database. The TriNetX database was queried for all laryngeal cancer patients ages 18-90 undergoing robotic surgery. Primary outcomes were five-year overall survival and 90-day rates of planned tracheostomy, postoperative gastrostomy, and overall complications. One-to-one propensity score matching was used to examine of the effect of tracheostomy and concurrent neck dissection on primary outcomes. 413 patients from 41 healthcare organizations were identified: 126 (30.6%) patients underwent neck dissection, 39 (9.4%) underwent tracheostomy, 94 (23.6%) required gastrostomy, and 43 (11.47%) incurred postoperative complications. Five-year overall survival for laryngeal cancer TORS patients was 72.41%. Before matching, neck dissection was associated with greater odds of overall complications (OR = 2.10, 95%CI = 1.08-4.07, p < 0.027) and gastrostomy (OR = 1.66, 95%CI = 1.06-2.59, p = 0.027). Tracheostomy was associated with greater odds of gastrostomy (OR = 6.80, 95%CI = 3.35-13.81, p < 0.001). Matching identified 115 with and without neck dissection and 34 patients with and without tracheostomy. After matching, neck dissection was no longer significantly associated with higher overall complication and gastrostomy rates. Post-matching effects of tracheostomy on outcomes could not be studied due to reduced overall numbers. TORS for laryngeal cancer has acceptable complication rates. Neck dissection was not associated with greater odds of complications or gastrostomy. Larger studies are needed to determine the effect of tracheostomy on complication and gastrostomy rates.