Robotic surgery shows promise for local control of OSCC

By Sarah Guy

In individuals with low-risk oropharyngeal squamous cell carcinoma (OSCC), treatment with transoral robotic surgery (TORS) alone can result in an excellent rate of local disease control for up to 3 years, report researchers.

Furthermore, the technique is associated with low surgical morbidity, according to the results of a study published in the Archives of Otolaryngology-Head and Neck Surgery.

"We strongly encourage other investigators to perform high-quality, single-arm, prospective, observational trials and encourage funding of multi-institutional phase 2 trials to confirm generalizability of the TORS techniques and outcomes," suggest Gregory Weinstein (University of Pennsylvania, Philadelphia, USA) et al.

The TORS technique was developed at the researchers' institution and involves placing a minimum of three arms of the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, California) into an OSCC patient's oral cavity to achieve tumor resection.

The team evaluated data for 30 such patients who underwent TORS alone between 2005 and 2010. Of these, 33% were pathologically node positive and 3% node negative - indicating tumor presence at the inked margin of the resection - after surgery.

After a minimum follow up of 18 months, and a mean of 2.7 years, rates of local, regional, and distant disease control in the cohort were 97%, 90%, and 100%, respectively. In addition, the whole group was alive at 18 months.

The high local control rates observed "provide assurance that in more advanced nodal disease following primary site treatment with TORS, greater confidence can be attributed to a negative margin," say Weinstein and colleagues.

Even in the single patient who experienced local recurrence and went on to receive chemoradiation, there was no regional or distant metastasis at last follow up (1 year and 7 months), and full nutrition was being maintained without the need for a feeding tube, note the authors.

Indeed, at the last follow up, all patients were on an oral diet without a feeding tube, they report.

During the 30 days after surgery, seven complications were observed. The majority of these, including temporomandibular joint capsulitis, postoperative seizure, and acute renal failure, resolved with medication, while some (brachycardia) resolved without intervention. No patient required a blood transfusion during surgery, and the average hospital stay was 3.6 days.

"In our opinion, the best way to ensure that other surgeons can reproduce our excellent outcomes is through our concise and clear articulation of the techniques via standardized and validated training," conclude the researchers.

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