Feasibility and safety of transoral robotic surgery (TORS) for early hypopharyngeal cancer: a subset analysis of the Hamburg University TORS-trial

Over the past 5 years, transoral robotic surgery (TORS) has become well established as one of the standard treatment options for T1 and T2 oropharyngeal squamous cell carcinoma. Besides this main indication, TORS can provide with improved access to other subsites of the upper aerodigestive tract as well, such as the supraglottic larynx and the hypopharynx, with superior visibility and maneuverability to that of transoral laser microsurgery (TOLM). Since September 2011, over one hundred TORS procedures have been performed at our institution, predominantly for oropharyngeal cancer. As part of our first 50 transoral robotic cases making up our initial TORS-trial, five patients underwent TORS for early hypopharyngeal carcinoma. The present case series evaluates its feasibility, safety and the completeness of resection in this well-defined subgroup of patients. Main outcome measures were completeness of resection, the presence or lack of postoperative bleeding, number of days intubated, rate of elective tracheotomy, duration of intensive care and/or intermediate care, speech and swallowing function, and duration of nasogastric and/or gastrostomy tube dependency. All patients have been free of recurrence to date. One patient died of other disease. Four patients are alive and free of tumour, three of them did not need adjuvant therapy. Transoral robotic surgery with appropriate neck dissection is a valid primary treatment option for select early hypopharyngeal carcinoma, especially in cases that did not require adjuvant treatment. In contrast to TOLM, TORS allows a multi-planar en bloc resection in the hypopharynx which makes histopathological evaluation more reliable. In addition to this, its faster learning curve makes the results less dependent on the individual surgeons’ capabilities.