Transoral robotic surgery for squamous cell carcinoma of the oropharynx in a primarily human papillomavirus-negative patient population

Abstract

Purpose

Transoral robotic surgery (TORS) is one of the main treatment options for non-locally advanced primary oropharyngeal cancer in the United States. However, its use is more limited in countries with a low incidence of human papillomavirus (HPV), such as Spain, in patients with advanced disease, and as salvage surgery. To shed light on the use and potential benefit of TORS in Spanish patients, we analyzed the functional and oncologic outcomes of TORS as both primary and salvage surgery in a primarily HPV-negative population which is representative of oropharyngeal squamous cell carcinoma (OPSCC) patients in Spain.

Material and methods

This is a retrospective analysis of prospectively collected data on OPSCC patients treated with TORS at our center between February 2017 and February 2019.

Results

Fifty-four OPSCC patients were included; 79.6% were males and 80.5% were HPV negative. Median age was 62 years. Primary surgery was performed on 73.7% (48.1% stage I–II; 51.9% stage III–IV) and salvage surgery on 25.9% of patients. Positive margin rates were 4.3% for T1–2 and 25.8% for T3–4. None of the stage I–II patients and 27.7% of stage III–IV patients required adjuvant treatment. Reconstructive surgery was performed in 19.2% of all patients. Normal swallowing was achieved in 92.7% of patients at 6 months after surgery. 1- and 2-year survival rates for all patients were 94.5% and 89%, respectively. The overall complication rate was 16.1%. Bleeding occurred in 11.5% of patients. Longer hospitalization time was associated with surgical complications (P = 0.03) and reconstructive surgery (P = 0.03) but not with salvage surgery.

Conclusion

TORS is a safe and effective treatment for HPV-negative T1–2 OPSCC patients. The positive margin rate was worse in T3–4 patients, indicating the need for careful patient selection in this subgroup.

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Abbreviations

ALT:

Anterolateral thigh

CRT:

Chemoradiotherapy

CT:

Computed tomography

ECE:

Extracapsular extension

FAMM:

Facial artery musculomucosal

FEES:

Fiberoptic endoscopic evaluation of swallowing

HPV:

Human papillomavirus

IMRT:

Intensity-modulated radiation therapy

MRI:

Magnetic resonance imaging

OPSCC:

Oropharyngeal squamous cell carcinoma

PCR:

Polymerase chain reaction

PET:

Positron emission tomography

RF:

Radial forearm

RT:

Radiotherapy

RTOG:

Radiation therapy oncology group

SCC:

Squamous cell carcinoma

SCORL:

Sociedad Catalana de Otorrinolaringología (Catalan Society of Otorhinolaryngology)

TORS:

Transoral robotic surgery

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Acknowledgments

This study received no outside funding.

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Correspondence to D. Viros Porcuna.

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Ethical approval

This study was approved by the ethics local committee at Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona (PI-17-267).

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Informed consent was obtained from all individuals included in the study.

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Viros Porcuna, D., Pollan Guisasola, C., Viña Soria, C. et al. Transoral robotic surgery for squamous cell carcinoma of the oropharynx in a primarily human papillomavirus-negative patient population. Clin Transl Oncol 22, 1303–1311 (2020). https://doi.org/10.1007/s12094-019-02256-y

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Keywords

  • Head and neck cancer
  • Oropharyngeal cancer
  • Reconstructive surgery
  • Salvage surgery
  • Squamous cell carcinoma
  • TORS