Robotic Surgery Shows Promise in Head and Neck Cancer Treatment
A new study suggest less-invasive robotic surgery for head and neck squamous cell carcinomas is as effective as other minimally invasive surgical techniques based on patient function and survival.
J. Scott Magnuson, M.D., University of Alabama at Birmingham otolaryngologist, and colleagues from UAB and the Mayo Clinic have published the results of their study in the Dec. 20, 2010 issue of the Archives of Otolaryngology - Head & Neck Surgery.
Head and neck squamous cell carcinomas (HNSCCs) account for about 4% of malignant tumors diagnosed in the United States each year. This corresponds to an estimated 17 per 100 000 persons with newly diagnosed HNSCC each year. Currently the standard minimally invasive surgery for these tumors is transoral laser microsurgery.
Transoral robotic surgery (TORS) has been shown in previous studies have shown to decrease overall patient morbidity and mortality, particularly in the ability to swallow after surgery. TORS is currently approved by the Food and Drug Administration for T1 and T2 oropharyngeal tumors.
Magnuson and colleagues looked at 89 patients with various stages of head and neck squamous cell carcinomas whose primary tumor was resected using the da Vinci Robot. Patients received their surgery at 1 of 2 tertiary care centers, University of Alabama at Birmingham or the Mayo Clinic in Rochester, Minnesota. All of the patients were monitored during their hospital stay and up to 33 months after surgery.
"The overall two-year survival rate for these patients was 86.3 percent, which is comparable to the standard treatment," Magnuson, also a scientist in the UAB Comprehensive Cancer Center, said. "Those with earlier-stage tumors appeared to have slightly better recurrence-free survival than those with later stages, but it was not statistically significant."
Magnuson said patient swallowing varied depending on the location of the tumor, preoperative swallowing ability, cancer stage and patient age, and their findings on function were consistent with previous research. Some patients, he said, tolerated an oral diet one to two days after surgery while some were discharged with a short-term nasal feeding tube or long-term gastric feeding tube, including some who were feeding tube-dependent prior to surgery.
"Of note," he added, "all of the patients in the study had regained full swallowing ability at the time of the last follow up visit and none remained feeding-tube dependent."
Magnuson said the study's results are encouraging and show robotic surgery offers a technically feasible and oncologically sound alternative treatment for some patients with head and neck squamous cell carcinomas, but he cautions more work needs to be done.
"This is a relatively new technique, and long-term oncologic outcomes are not available," he said. "However, the early functional and oncologic results justify the continued treatment of select patients with head and neck squamous cell carcinomas with robotic-assisted surgeries."
Hilliary N. White; Eric J. Moore; Eben L. Rosenthal; William R. Carroll; Kerry D. Olsen; Renee A. Desmond; J. Scott Magnuson; Transoral Robotic-Assisted Surgery for Head and Neck Squamous Cell Carcinoma: One- and 2-Year Survival Analysis; Arch Otolaryngol Head Neck Surg. 2010;136(12):1248-1252.