Trans-oral robotic surgery (TORS) has changed surgical management of patients with oropharyngeal squamous cell carcinomas (OPSCC). In this study we present surgical and oncologic outcomes of patients with oropharyngeal squamous cell carcinomas, treated using TORS, with and without an adjuvant therapy. Sixty patients with oropharyngeal squamous cell carcinomas treated with TORS between January 2008 and December 2017 have been retrospectively evaluated considering clinicopathologic features, disease characteristics, adjuvant treatments and oncological outcomes. TORS was performed for OPSCC to the base of tongue in 41.7%, tonsils in 46.7%, soft palate and posterior pharyngeal wall in 3.3% and 5%, respectively. Neck dissection was performed in 43.3% of patients. Management strategies included surgery alone in 30%, TORS and adjuvant radiotherapy in 33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year overall survival of the total group was 77.6%, the 5-year disease-free survival rate was 85.2%, and the 5-year local recurrence-free survival rate was 90.6%. Finally, in selected patients TORS appears to yield similar oncologic outcomes and functional outcomes to traditional techniques and non-operative treatment with a possible benefit on long-term quality of life. The future offers exciting opportunities to combine TORS and radiotherapy in unique ways. However, further research is urgently needed to clarify the indications for adjuvant therapy following TORS resections.

Nell’ultimo decennio, la chirurgia robotica trans-orale (TORS) ha rivoluzionato la gestione chirurgica dei pazienti con carcinoma dell’orofaringe(OPSCC). Questo studio monocentrico presenta i risultati oncologici delle neoplasie orofaringee trattate con TORS con e senza terapia adiuvante nei primi nove anni della nostra esperienza robotica. Sessanta pazienti sono stati trattati tra gennaio 2008 e dicembre 2017. Sono stati acquisiti i dati riguardanti le caratteristiche clinico-patologiche, i trattamenti adiuvanti e gli esiti oncologici. La TORS è stata eseguita per OPSCC della base della lingua nel 41,7% dei casi; nel 46,7% per carcinoma tonsillare, mentre neoplasie del palato molle e/o della parete posteriore faringea sono state rispettivamente il 3,3% e 5% dei casi. La svuotamento del collo è stato eseguito nel 43,3% dei pazienti. Le strategie di gestione includevano la sola chirurgia nel 30% dei casi, TORS e radioterapia adiuvante nel 33,3% e TORS e radiochemioterapia adiuvante nel 36,7%. La sopravvivenza globale a 5 anni del gruppo totale è del 77,6%, il tasso di sopravvivenza libera da malattia a 5 anni è dell’85,2% e il tasso di sopravvivenza libera da recidiva locale a 5 anni è del 90,6%. Infine, in alcuni pazienti selezionati, la TORS sembra fornire esiti oncologici e funzionali simili alle tecniche tradizionali e al trattamento di preservazione d’organo con un possibile beneficio per la qualità della vita a lungo termine. Tuttavia, ulteriori ricerche sono urgentemente necessarie per chiarire le indicazioni e l’erogazione della terapia adiuvante dopo le resezioni TORS.

Trans-oral robotic surgery for the management of oropharyngeal carcinomas: A 9-year institutional experience [Chirurgia transorale robotica per il trattamento del carcinoma orofaringeo: esperienza di 9 anni]

Vicini C.
Ultimo
2019

Abstract

Trans-oral robotic surgery (TORS) has changed surgical management of patients with oropharyngeal squamous cell carcinomas (OPSCC). In this study we present surgical and oncologic outcomes of patients with oropharyngeal squamous cell carcinomas, treated using TORS, with and without an adjuvant therapy. Sixty patients with oropharyngeal squamous cell carcinomas treated with TORS between January 2008 and December 2017 have been retrospectively evaluated considering clinicopathologic features, disease characteristics, adjuvant treatments and oncological outcomes. TORS was performed for OPSCC to the base of tongue in 41.7%, tonsils in 46.7%, soft palate and posterior pharyngeal wall in 3.3% and 5%, respectively. Neck dissection was performed in 43.3% of patients. Management strategies included surgery alone in 30%, TORS and adjuvant radiotherapy in 33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year overall survival of the total group was 77.6%, the 5-year disease-free survival rate was 85.2%, and the 5-year local recurrence-free survival rate was 90.6%. Finally, in selected patients TORS appears to yield similar oncologic outcomes and functional outcomes to traditional techniques and non-operative treatment with a possible benefit on long-term quality of life. The future offers exciting opportunities to combine TORS and radiotherapy in unique ways. However, further research is urgently needed to clarify the indications for adjuvant therapy following TORS resections.
2019
Meccariello, G.; Montevecchi, F.; D'Agostino, G.; Iannella, G.; Calpona, S.; Parisi, E.; Costantini, M.; Cammaroto, G.; Gobbi, R.; Firinu, E.; Sgarzani, R.; Nestola, D.; Bellini, C.; De Vito, A.; Amadori, E.; Vicini, C.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2414495
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