Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption

Laryngoscope. 2019 Aug;129(8):1844-1855. doi: 10.1002/lary.27740. Epub 2018 Dec 21.

Abstract

Objectives: To compare long-term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM).

Study design: A retrospective analysis of the National Cancer Database (2010-2014).

Methods: Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi-square tests; Kaplan-Meier log-rank test; and Cox multivariate, logistic regression, and multinomial regression modeling.

Results: We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001). TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303).

Conclusion: The advantages of TORS for early-stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy.

Level of evidence: NA Laryngoscope, 129:1844-1855, 2019.

Keywords: Transoral robotic surgery; head and neck cancer; oropharyngeal cancer; robotic surgery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy, Adjuvant / mortality
  • Chi-Square Distribution
  • Combined Modality Therapy
  • Databases, Factual
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Margins of Excision
  • Middle Aged
  • Multivariate Analysis
  • Natural Orifice Endoscopic Surgery / methods
  • Natural Orifice Endoscopic Surgery / mortality*
  • Neoplasm Staging
  • Oropharyngeal Neoplasms / mortality
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / therapy*
  • Proportional Hazards Models
  • Regression Analysis
  • Retrospective Studies
  • Robotic Surgical Procedures / methods
  • Robotic Surgical Procedures / mortality*
  • Treatment Outcome
  • United States