Paul Mazerolle1, Pierre Philouze2, Renaud Garrel3, Karine Aubry4, Sylvain Morinière5, Sophie El Bedoui6, Jean Ton Van6, Christophe Ferron7, Olivier Malard7, Franck Jegoux8, Emilie Berard9, Sébastien Vergez10. 1. Department of Surgery, University Cancer Institute Toulouse-Oncopole University Hospital of Toulouse, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France. 2. Department of Head and Neck Surgery, Hospices Civils de Lyon, Lyon-Nord University Hospital, 103 Grande Rue de la Croix Rousse, 69000 Lyon, France. 3. Department of Head and Neck Surgery, Montpellier Guy De Chauliac University Hospital, 80 Avenue Augustin Fliche, 34000 Montpellier, France. 4. Department of Head and Neck Surgery, Limoges Dupuytrens University Hospital, 2 Avenue Martin Luther King, 87000 Limoges, France. 5. Department of Head and Neck Surgery, Tours Bretonneau University Hospital, 2 Boulevard Tonnellé, 37000 Tours, France. 6. Department of Head and Neck Surgery, Lille Oscar Lambret Cancer Care Center, 3 Rue Frederic Combemale, 59000 Lille, France. 7. Department of Head and Neck Surgery, Nantes University Hospital, 1 Place Alexis-Ricordeau, 44000 Nantes, France. 8. Department of Head and Neck Surgery, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000 Rennes, France. 9. Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-Toulouse University, Toulouse University Hospital (CHU), Toulouse, France. 10. Department of Surgery, University Cancer Institute Toulouse-Oncopole University Hospital of Toulouse, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France. Electronic address: vergez.s@chu-toulouse.fr.
Abstract
BACKGROUND: Pyriform sinus carcinomas (SCC) present specific functional and oncological issues. The recent advent of trans-oral robotic surgery (TORS), as a conservative procedure, has opened up new perspectives. OBJECTIVES: To present the oncological and functional outcomes of TORS for pyriform sinus SCC. MATERIALS AND METHODS: We included, retrospectively, all TORS procedures for pyriform sinus SCC performed between 2009 and 2017 in eight French tertiary referral centers. We excluded lesions involving the pyriform sinus that had developed from the oropharynx, larynx, or other anatomic sub-sites of the hypopharynx. RESULTS: We included 57 TORS procedures. Median hospital stay was 10 days. A preventive tracheotomy was performed in seven cases (12%), and all were successfully decannulated. Oral re-feeding was possible for 93%, after a median of 5 days. The main surgical complications were hemorrhages (three cases), all successfully handled, although 2 patients with heavy comorbidities died from blood loss in the days after. Adjuvant therapy was proposed in 31 cases (54%), including two cases of salvage surgery (total pharyngolaryngectomy). After a median follow-up of 23 months, overall and disease-free survival were, respectively, 84% and 74% at 24 months, and 66% and 50% at 48 months. At the end of follow-up, organ preservation rate was 96%. None of the surviving patients needed a tracheotomy and oral diet was possible for 96%. CONCLUSION: The functional and oncological outcomes of TORS for pyriform sinus cancer are encouraging, and this procedure can be considered safe for selected early or moderately advanced cases as a conservative treatment.
BACKGROUND: Pyriform sinus carcinomas (SCC) present specific functional and oncological issues. The recent advent of trans-oral robotic surgery (TORS), as a conservative procedure, has opened up new perspectives. OBJECTIVES: To present the oncological and functional outcomes of TORS for pyriform sinus SCC. MATERIALS AND METHODS: We included, retrospectively, all TORS procedures for pyriform sinus SCC performed between 2009 and 2017 in eight French tertiary referral centers. We excluded lesions involving the pyriform sinus that had developed from the oropharynx, larynx, or other anatomic sub-sites of the hypopharynx. RESULTS: We included 57 TORS procedures. Median hospital stay was 10 days. A preventive tracheotomy was performed in seven cases (12%), and all were successfully decannulated. Oral re-feeding was possible for 93%, after a median of 5 days. The main surgical complications were hemorrhages (three cases), all successfully handled, although 2 patients with heavy comorbidities died from blood loss in the days after. Adjuvant therapy was proposed in 31 cases (54%), including two cases of salvage surgery (total pharyngolaryngectomy). After a median follow-up of 23 months, overall and disease-free survival were, respectively, 84% and 74% at 24 months, and 66% and 50% at 48 months. At the end of follow-up, organ preservation rate was 96%. None of the surviving patients needed a tracheotomy and oral diet was possible for 96%. CONCLUSION: The functional and oncological outcomes of TORS for pyriform sinus cancer are encouraging, and this procedure can be considered safe for selected early or moderately advanced cases as a conservative treatment.
Keywords:
Head and neck cancer; Hypopharyngeal squamous cell carcinoma; Organ preservation; Pyriform sinus cancer; Robotic hypopharyngectomy; Transoral robotic surgery