Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-08-2017 | Head and Neck

What should we expect from robotic surgery for second primary oropharyngeal cancer?

Authors: Tuan-Jen Fang, Li-Ang Lee, Bing-Shan Huang, Chien-Yu Lin, Cheng-Lung Hsu, Joseph Tung-Chieh Chang, Tzu-Chen Yen, Chun-Ta Liao, Hui-Chen Chiang

Published in: European Archives of Oto-Rhino-Laryngology | Issue 8/2017

Abstract

The outcomes of second primary oropharyngeal cancer (SPOPC) may not be determined by oropharyngeal cancer but from the other index cancer as well. The management of (SPOPC) remains inconclusive and limited. Transoral robotic surgery (TORS) to maximize the functional outcomes without reducing oncologic effect is suggested as the primary treatment for selected oropharyngeal cancer. This study aimed to evaluate the feasibility and outcomes of TORS for the management of SPOPC. Patients who underwent TORS from January 2011 to June 2015 at a tertian referral center in Taiwan were recruited. Loco-regional status, overall survival (OS), disease-specific survival (DSS), and postoperative functional status were evaluated. Fifteen patients received TORS for SPOPC with curative intent, including eleven with tongue-base carcinomas, and four with tonsil carcinomas. One case was terminated because of inadequate exposure and the other 14 cases were completed with negative pathologic margins. Two-year OS and DSS were 53 and 77%, respectively. Patients with SPOPC occurring within 6 months had poorer outcomes (p = 0.044). The median time to feeding-tube removal was 5 days, and one patient had long-term gastric-tube dependence. Patients of age <65 years with synchronous SPOPC and esophageal cancer as the other index cancer were significant worse in oncologic outcomes. We concluded that TORS is a feasible alternative treatment in selected patients with SPOPC. Patients with metachronous T1–2 SPOPC without an esophageal primary can achieve excellent survival after TORS, while TORS can maximize functional preservation with limited destruction in patients with low life expectancy.

Taiwan Cancer Registry, Health Promotion Administration, Ministry of Health and Welfare. Cancer Registry Annual Report 2013. http://www.hpa.gov.tw/. Accessed 14 Apr 2017

Huang SH, Hansen A, Rathod S, O’Sullivan B (2015) Primary surgery versus (chemo)radiotherapy in oropharyngeal cancer: the radiation oncologist’s and medical oncologist’s perspectives. Curr Opin Otolaryngol Head Neck Surg 23:139–147CrossRefPubMed

Chung TK, Rosenthal EL, Magnuson JS, Carroll WR (2015) Transoral robotic surgery for oropharyngeal and tongue cancer in the United States. Laryngoscope 125:140–145CrossRefPubMed

Genden EM, Desai S, Sung CK (2009) Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck 31:283–289CrossRefPubMed

Kelly K, Johnson-Obaseki S, Lumingu J, Corsten M (2014) Oncologic, functional and surgical outcomes of primary transoral robotic surgery for early squamous cell cancer of the oropharynx: a systematic review. Oral Oncol 50:696–703CrossRefPubMed

Lorincz BB, Mockelmann N, Busch CJ, Knecht R (2015) Functional outcomes, feasibility, and safety of resection of transoral robotic surgery: single-institution series of 35 consecutive cases of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck 37:1618–1624. doi:10.1002/hed.23809 CrossRefPubMed

Holsinger FC, Ferris RL (2015) Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx cancer: robotics, lasers, and clinical trials. J Clin Oncol 33:3285–3292CrossRefPubMedPubMedCentral

Sload R, Silver N, Jawad BA, Gross ND (2016) The role of transoral robotic surgery in the management of HPV negative oropharyngeal squamous cell carcinoma. Curr Oncol Rep 18:53CrossRefPubMed

Lorincz BB, Mockelmann N, Busch CJ, Munscher A, Sehner S, Dalchow CV, Knecht R (2015) Two-year survival analysis of 50 consecutive head and neck cancer patients treated with transoral robotic surgery in a single European centre. Ann Surg Oncol. doi:10.1245/s10434-015-4581-5 PubMed

10.

Weinstein GS, Quon H, Newman HJ, Chalian JA, Malloy K, Lin A, Desai A, Livolsi VA, Montone KT, Cohen KR et al (2012) Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg 138:628–634CrossRefPubMed

11.

White H, Ford S, Bush B, Holsinger FC, Moore E, Ghanem T, Carroll W, Rosenthal E, Sweeny L, Magnuson JS (2013) Salvage surgery for recurrent cancers of the oropharynx: comparing TORS with standard open surgical approaches. JAMA Otolaryngol Head Neck Surg 139:773–778CrossRefPubMed

12.

O’Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG (2006) Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116:1465–1472CrossRefPubMed

13.

Liao CT, Kang CJ, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Cheng AJ, Chen IH et al (2007) Survival of second and multiple primary tumors in patients with oral cavity squamous cell carcinoma in the betel quid chewing area. Oral Oncol 43:811–819CrossRefPubMed

14.

Qaisi M, Vorrasi J, Lubek J, Ord R (2014) Multiple primary squamous cell carcinomas of the oral cavity. J Oral Maxillofac Surg 72:1511–1516CrossRefPubMed

15.

Adel M, Liao CT, Lee LY, Hsueh C, Lin CY, Fan KH, Wang HM, Ng SH, Lin CH, Tsao CK et al (2016) Incidence and outcomes of patients with oral cavity squamous cell carcinoma and fourth primary tumors: a long-term follow-up study in a betel quid chewing endemic area. Medicine 95:e2950CrossRefPubMedPubMedCentral

16.

Liao C-T, Fan K-H, Kang C-J, Lin C-Y, Chang JT-C, Tsang N-M, Huang B-S, Chao Y-K, Lee L-Y, Hsueh C et al (2015) Clinical outcomes of patients with resected oral cavity cancer and simultaneous second primary malignancies. PLoS One 10:e0136918CrossRefPubMedPubMedCentral

17.

Weinstein GS, O’Malley BW Jr, Rinaldo A, Silver CE, Werner JA, Ferlito A (2015) Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer. Eur Arch Otorhinolaryngol 272:1551–1552. doi:10.1007/s00405-014-3331-9 CrossRefPubMed

18.

Su HK, Ozbek U, Likhterov I, Brant J, Genden EM, Urken ML, Chai RL (2016) Safety of transoral surgery for oropharyngeal malignancies: an analysis of the ACS NSQIP. Laryngoscope 126:2484–2491CrossRefPubMed

19.

Wilkie MD, Upile NS, Lau AS, Williams SP, Sheard J, Helliwell TR, Robinson M, Rodrigues J, Beemireddy K, Lewis-Jones H et al (2016) Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: a paradigm shift in therapeutic approach. Head Neck 38:1263–1270CrossRefPubMed

20.

Satava RM (2002) Surgical robotics: the early chronicles: a personal historical perspective. Surg Laparosc Endosc Percutaneous Tech 12:6–16CrossRef

21.

Kwoh YS, Hou J, Jonckheere EA, Hayati S (1988) A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng 35:153–160CrossRefPubMed

22.

Al-Swiahb JN, Huang CC, Fang FM, Chuang HC, Huang HY, Luo SD, Chen CH, Chen CM, Chien CY (2010) Prognostic impact of p16, p53, epidermal growth factor receptor, and human papillomavirus in oropharyngeal cancer in a betel nut-chewing area. Arch Otolaryngol Head Neck Surg 136:502–508CrossRefPubMed

23.

Wang HM, Cheng NM, Lee LY, Fang YH, Chang JT, Tsan DL, Ng SH, Liao CT, Yang LY, Yen TC (2016) Heterogeneity of (18)F-FDG PET combined with expression of EGFR may improve the prognostic stratification of advanced oropharyngeal carcinoma. Int J Cancer 138:731–738CrossRefPubMed

24.

Patel SN, Cohen MA, Givi B, Dixon BJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, de Almeida JR, Higgins KM et al (2016) Salvage surgery for locally recurrent oropharyngeal cancer. Head Neck 38(Suppl 1):E658–E664CrossRefPubMed

25.

Sweeny L, Rosenthal EL, Clemons L, Stevens TM, Cook McIntosh ER, Carroll WR (2016) Outcomes after surgical salvage for recurrent oropharyngeal squamous cell carcinoma. Oral Oncol 60:118–124CrossRefPubMed

26.

Richmon JD, Feng AL, Yang W, Starmer H, Quon H, Gourin CG (2014) Feasibility of rapid discharge after transoral robotic surgery of the oropharynx. Laryngoscope 124:2518–2525CrossRefPubMed

27.

de Almeida JR, Byrd JK, Wu R, Stucken CL, Duvvuri U, Goldstein DP, Miles BA, Teng MS, Gupta V, Genden EM (2014) A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope 124:2096–2102CrossRefPubMed

28.

Choe KS, Haraf DJ, Solanki A, Cohen EE, Seiwert TY, Stenson KM, Blair EA, Portugal L, Villaflor VM, Witt ME et al (2011) Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer 117:4671–4678CrossRefPubMed

29.

Salama JK, Vokes EE, Chmura SJ, Milano MT, Kao J, Stenson KM, Witt ME, Haraf DJ (2006) Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 64:382–391CrossRefPubMed

30.

Sulman EP, Schwartz DL, Le TT, Ang KK, Morrison WH, Rosenthal DI, Ahamad A, Kies M, Glisson B, Weber R et al (2009) IMRT reirradiation of head and neck cancer-disease control and morbidity outcomes. Int J Radiat Oncol Biol Phys 73:399–409CrossRefPubMed

31.

Chen MF, Yang YH, Lai CH, Chen PC, Chen WC (2013) Outcome of patients with esophageal cancer: a nationwide analysis. Ann Surg Oncol 20:3023–3030CrossRefPubMed

32.

Lee JS, Ahn JY, Choi KD, Song HJ, Kim YH, Lee GH, Jung HY, Ryu JS, Kim SB, Kim JH et al (2016) Synchronous second primary cancers in patients with squamous esophageal cancer: clinical features and survival outcome. Korean J Intern Med 31:253–259CrossRefPubMedPubMedCentral

Title: What should we expect from robotic surgery for second primary oropharyngeal cancer?
Authors: Tuan-Jen Fang
Li-Ang Lee
Bing-Shan Huang
Chien-Yu Lin
Cheng-Lung Hsu
Joseph Tung-Chieh Chang
Tzu-Chen Yen
Chun-Ta Liao
Hui-Chen Chiang
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 8/2017
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-017-4594-8

At a glance: The STEP trials

Springer Medicine

What should we expect from robotic surgery for second primary oropharyngeal cancer?

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2017

Systematic radiographic evaluation of three potential implantation sites for a semi-implantable bone conduction device in 52 patients after previous mastoid surgery

A multicenter study on objective and subjective benefits with a transcutaneous bone-anchored hearing aid device: first Nordic results

Translation and transcultural adaptation of the VHI-10 questionnaire: the VHI-10lb

The origin of failure, and an opportunity to learn

“A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial”: something else about Gans maneuver

Contralateral sinus involvement of surgically treated unilateral allergic fungal rhinosinusitis