The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Cancer: A Review of the Literature

Background. Transoral robotic surgery (TORS) is an emerging treatment option for the treatment of head and neck malignancies, particularly for oropharyngeal squamous cell carcinoma (OPSCC). Preliminary studies have demonstrated excellent oncologic and functional outcomes that have led to a resurgence of interest in the primary surgical management of OPSCC. The aim of the present study was to review the evidence base supporting the use of TORS in OPSCC. Methods. Studies evaluating the application of TORS in the treatment of head and neck squamous cell carcinoma (HNSCC), and more specifically OPSCC, were identified for review. Further searches were made of reference lists for complete evaluation of minimally invasive surgery (MIS) in treating OPSCC. Results. Seventeen results relating to the application of TORS in treatment of OPSCC were identified. Further results relating to the role of transoral laser microsurgery (TLM) in OPSCC were included for review. Feasibility, oncologic, and functional data is summarized and discussed. Discussion. Management strategies for patients with OPSCC continue to evolve. Minimally invasive surgical techniques including TORS and TLM offer impressive functional and oncologic outcomes particularly for patients with early T-classification and low-volume regional metastatic disease. Potential exists for treatment deintensification, particularly in patients who are HPV positive.

[1]  W. Hong,et al.  Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. , 1991, The New England journal of medicine.

[2]  M. Zelefsky,et al.  Performance status after treatment for squamous cell cancer of the base of tongue--a comparison of primary radiation therapy versus primary surgery. , 1994, International journal of radiation oncology, biology, physics.

[3]  S. Stringer,et al.  Oropharyngeal carcinoma treated with radiotherapy: a 30-year experience. , 1996, International journal of radiation oncology, biology, physics.

[4]  R. Lewensohn,et al.  Human papillomavirus (HPV) DNA in tonsillar cancer: Clinical correlates, risk of relapse, and survival , 2000, International journal of cancer.

[5]  B. Rose,et al.  Human papillomavirus positivity predicts favourable outcome for squamous carcinoma of the tonsil , 2003, International journal of cancer.

[6]  M. Kron,et al.  Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue. , 2003, Archives of otolaryngology--head & neck surgery.

[7]  G. Weinstein,et al.  Maintenance of Hemostasis in Transoral Robotic Surgery , 2005, ORL.

[8]  G. Weinstein,et al.  Transoral Robotic Surgery: Supraglottic Laryngectomy in a Canine Model , 2005, The Laryngoscope.

[9]  D. Brasnu,et al.  Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence. , 2005, Archives of otolaryngology--head & neck surgery.

[10]  O. Laccourreye,et al.  Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results. , 2005, Archives of otolaryngology--head & neck surgery.

[11]  G. Weinstein,et al.  Assessment of Intraoperative Safety in Transoral Robotic Surgery , 2006, The Laryngoscope.

[12]  L. Mariani,et al.  High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  Margie Hunt,et al.  Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. , 2006, International journal of radiation oncology, biology, physics.

[14]  G. Weinstein,et al.  Transoral Robotic Surgery (TORS) for Base of Tongue Neoplasms , 2006, The Laryngoscope.

[15]  Christopher U. Jones,et al.  Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. , 2006, The New England journal of medicine.

[16]  Brian O'Sullivan,et al.  Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis , 2006, The Lancet.

[17]  G. Weinstein,et al.  Transoral robotic surgery: radical tonsillectomy. , 2007, Archives of otolaryngology--head & neck surgery.

[18]  A. Garden,et al.  Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  D. Heron,et al.  Role of Surgery in Limited (T1‐2, N0‐1) Cancers of the Oropharynx , 2008, The Laryngoscope.

[20]  D. Raben,et al.  Effect of Radiation Techniques in Treatment of Oropharynx Cancer , 2008, The Laryngoscope.

[21]  P. Xia,et al.  Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma , 2008, Cancer.

[22]  Joshua D. Lawson,et al.  Concurrent platinum‐based chemotherapy and simultaneous modulated accelerated radiation therapy for locally advanced squamous cell carcinoma of the tongue base , 2008, Head & neck.

[23]  K. Olsen,et al.  Transoral robotic surgery for oropharyngeal squamous cell carcinoma: A prospective study of feasibility and functional outcomes , 2009, The Laryngoscope.

[24]  S. Spencer,et al.  Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. , 2009, International journal of radiation oncology, biology, physics.

[25]  E. Choi,et al.  Feasibility of transoral lateral oropharyngectomy using a robotic surgical system for tonsillar cancer. , 2009, Oral oncology.

[26]  E. Rosenthal,et al.  Robot-assisted surgery for upper aerodigestive tract neoplasms. , 2009, Archives of otolaryngology--head & neck surgery.

[27]  P. Sparén,et al.  Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden: An epidemic of viral‐induced carcinoma? , 2009, International journal of cancer.

[28]  W. Thorstad,et al.  Transoral laser microsurgery (TLM) ± adjuvant therapy for advanced stage oropharyngeal cancer , 2009, The Laryngoscope.

[29]  William C. Perry,et al.  Oropharyngeal cancer: a case for single modality treatment with transoral laser microsurgery. , 2009, Archives of otolaryngology--head & neck surgery.

[30]  E. Genden,et al.  Transoral robotic assisted free flap reconstruction , 2009, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[31]  Jonathan R. Clark,et al.  Outcomes of primary surgical treatment of T1 and T2 carcinomas of the oropharynx , 2009, The Laryngoscope.

[32]  E. Rosenthal,et al.  Functional Outcomes after Transoral Robotic Surgery for Head and Neck Cancer , 2009, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[33]  E. Genden,et al.  Transoral robotic surgery for the management of head and neck cancer: A preliminary experience , 2009, Head & neck.

[34]  David W. Taggart,et al.  No surgical innovation without evaluation: the IDEAL recommendations , 2009, The Lancet.

[35]  K. Olsen,et al.  Transoral resection for squamous cell carcinoma of the base of the tongue. , 2009, Archives of otolaryngology--head & neck surgery.

[36]  C. W. Cummings,et al.  Cummings otolaryngology--head & neck surgery , 2010 .

[37]  G. Weinstein,et al.  Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: A subset analysis of the university of pennsylvania transoral robotic surgery trial , 2010, The Laryngoscope.

[38]  E. Rosenthal,et al.  Transoral robotic-assisted surgery for head and neck squamous cell carcinoma: one- and 2-year survival analysis. , 2010, Archives of otolaryngology--head & neck surgery.

[39]  F. Montevecchi,et al.  Transoral Robotic Tongue Base Resection in Obstructive Sleep Apnoea-Hypopnoea Syndrome: A Preliminary Report , 2010, ORL.

[40]  Jesse C Selber,et al.  Transoral Robotic Reconstruction of Oropharyngeal Defects: A Case Series , 2010, Plastic and reconstructive surgery.

[41]  M. Gapany.  Transoral Laser Microsurgery (TLM)±Adjuvant Therapy for Advanced Stage Oropharyngeal Cancer: Outcomes and Prognostic Factors , 2010 .

[42]  E. Rosenthal,et al.  Robotic-assisted surgery for primary or recurrent oropharyngeal carcinoma. , 2010, Archives of otolaryngology--head & neck surgery.

[43]  D. Finkelstein,et al.  Bcl2 and Human Papilloma Virus 16 as Predictors of Outcome following Concurrent Chemoradiation for Advanced Oropharyngeal Cancer , 2010, Clinical Cancer Research.

[44]  G. Weinstein,et al.  Transoral robotic surgery for advanced oropharyngeal carcinoma. , 2010, Archives of otolaryngology--head & neck surgery.

[45]  C. Mathers,et al.  Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 , 2010, International journal of cancer.

[46]  G. Weinstein,et al.  Transoral Robotic Free Flap Reconstruction of Oropharyngeal Defects: A Preclinical Investigation , 2010, Plastic and reconstructive surgery.

[47]  K. Ang,et al.  Human papillomavirus and survival of patients with oropharyngeal cancer. , 2010, The New England journal of medicine.

[48]  J. Staffurth,et al.  A review of the clinical evidence for intensity-modulated radiotherapy. , 2010, Clinical oncology (Royal College of Radiologists (Great Britain)).

[49]  Marc Remacle,et al.  Transoral robotic surgery for the management of head and neck tumors: learning curve , 2011, European Archives of Oto-Rhino-Laryngology.

[50]  G. Weinstein,et al.  Transoral robotic surgery and human papillomavirus status: Oncologic results , 2011, Head & neck.

[51]  K. Aubry,et al.  Transoral robotic surgery for head and neck cancer: a series of 17 cases. , 2011, European annals of otorhinolaryngology, head and neck diseases.

[52]  R. Hayden,et al.  Transoral laser microsurgery as primary treatment for advanced‐stage oropharyngeal cancer: A united states multicenter study , 2011, Head & neck.

[53]  R. Walvekar,et al.  Robotic-assisted transoral removal of a bilateral floor of mouth ranulas , 2011, World journal of surgical oncology.

[54]  T. Ghanem,et al.  Transoral robotic‐assisted microvascular reconstruction of the oropharynx , 2011, The Laryngoscope.

[55]  R. Gibbs,et al.  Exome Sequencing of Head and Neck Squamous Cell Carcinoma Reveals Inactivating Mutations in NOTCH1 , 2011, Science.

[56]  E. Genden,et al.  The role of reconstruction for transoral robotic pharyngectomy and concomitant neck dissection. , 2011, Archives of otolaryngology--head & neck surgery.

[57]  J. Pignon,et al.  Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumour site. , 2011, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[58]  E. Garfein,et al.  Transoral robotic reconstructive surgery reconstruction of a tongue base defect with a radial forearm flap. , 2011, Plastic and reconstructive surgery.

[59]  B. Haughey,et al.  Swallowing function after transoral laser microsurgery (TLM) ± adjuvant therapy for advanced‐stage oropharyngeal cancer , 2011, The Laryngoscope.

[60]  A. McKenna,et al.  The Mutational Landscape of Head and Neck Squamous Cell Carcinoma , 2011, Science.

[61]  E. Genden,et al.  Transoral robotic resection and reconstruction for head and neck cancer , 2011, The Laryngoscope.

[62]  R. Walvekar,et al.  Robotic‐assisted transoral removal of a submandibular megalith , 2011, The Laryngoscope.

[63]  A. Nacci,et al.  Transoral robotic surgery of the tongue base in obstructive sleep Apnea‐Hypopnea syndrome: Anatomic considerations and clinical experience , 2012, Head & neck.