Pierre Gazda1,2, Clément Gauche3,4, Léonor Chaltiel5, Emilien Chabrillac3,4, Benjamin Vairel3,4, Guillaume De Bonnecaze4, Agnès Dupret-Bories3, Thomas Filleron5, Sébastien Vergez3,4. 1. Department of ENT Head and Neck Surgery, Institut Claudius Regaud, IUCT-Oncopole, 1 Av. Irène Joliot-Curie, 31059, Toulouse, France. pierre.gazda@gmail.com. 2. Department of ENT Head and Neck Surgery, CHU Larrey, 24 chemin de Pourvourville, 31400, Toulouse, France. pierre.gazda@gmail.com. 3. Department of ENT Head and Neck Surgery, Institut Claudius Regaud, IUCT-Oncopole, 1 Av. Irène Joliot-Curie, 31059, Toulouse, France. 4. Department of ENT Head and Neck Surgery, CHU Larrey, 24 chemin de Pourvourville, 31400, Toulouse, France. 5. Department of Biostatistics, Institut Claudius Regaud, IUCT Oncopole, 1 Av. Irène Joliot-Curie, 31059, Toulouse, France.
Abstract
PURPOSE: Transoral robotic surgery (TORS) as a first-line therapy has been well-documented but evidence is missing regarding salvage therapy. The aim of this study is to compare the oncological and functional outcomes of TORS as a primary and salvage therapy. METHODS: This retrospective monocentric study included 74 patients operated by a single surgeon and sorted out into two groups: primary treatment (PT) or Salvage treatment (ST) in case of previous history of radiation therapy. Patients were further stratified by tumour location: larynx and pharynx (lST vs lPT and pST vs pPT). RESULTS: Forty-eight patients were included in PT group (64.9%) and 26 in ST group (35.1%). ST patients had more frequent cTis/T1 tumours (57.7% vs 29.2%, p = 0.0164) and no clinical lymph disease (3.8% vs 37.5%, p = 0.0016). Tracheostomy was more often performed in the ST group (57.7% vs 16.7%, p = 0.0003) and the lST subgroup (88.9% vs 9.1%, p < 0.0001). Gastric feeding tube placement was more frequent in the ST group (76.9% vs 33.3%, p = 0.0003), the pST subgroup (64.7% vs 15.4%, p = 0.0009) and the lST subgroup (100% vs 54.5%, p = 0.0297). We observed a trend for more postoperative complications in the ST group (69.2% vs 47.9%, p = 0.0783). The overall survival was lower in the ST group (p = 0.0004), and in the pST subgroup (p < 0.0001). The disease-free survival rate was lower in the ST group (p = 0.0001), the pST subgroup (p = 0.0002) and the lST subgroup (p = 0.0328). CONCLUSION: This study confirms that survival and functional outcomes after salvage TORS are worse than in first line surgery.
PURPOSE: Transoral robotic surgery (TORS) as a first-line therapy has been well-documented but evidence is missing regarding salvage therapy. The aim of this study is to compare the oncological and functional outcomes of TORS as a primary and salvage therapy. METHODS: This retrospective monocentric study included 74 patients operated by a single surgeon and sorted out into two groups: primary treatment (PT) or Salvage treatment (ST) in case of previous history of radiation therapy. Patients were further stratified by tumour location: larynx and pharynx (lST vs lPT and pST vs pPT). RESULTS: Forty-eight patients were included in PT group (64.9%) and 26 in ST group (35.1%). ST patients had more frequent cTis/T1 tumours (57.7% vs 29.2%, p = 0.0164) and no clinical lymph disease (3.8% vs 37.5%, p = 0.0016). Tracheostomy was more often performed in the ST group (57.7% vs 16.7%, p = 0.0003) and the lST subgroup (88.9% vs 9.1%, p < 0.0001). Gastric feeding tube placement was more frequent in the ST group (76.9% vs 33.3%, p = 0.0003), the pST subgroup (64.7% vs 15.4%, p = 0.0009) and the lST subgroup (100% vs 54.5%, p = 0.0297). We observed a trend for more postoperative complications in the ST group (69.2% vs 47.9%, p = 0.0783). The overall survival was lower in the ST group (p = 0.0004), and in the pST subgroup (p < 0.0001). The disease-free survival rate was lower in the ST group (p = 0.0001), the pST subgroup (p = 0.0002) and the lST subgroup (p = 0.0328). CONCLUSION: This study confirms that survival and functional outcomes after salvage TORS are worse than in first line surgery.
Authors: William Stokes; Jad Ramadan; Georges Lawson; F Robert L Ferris; Floyd Christopher Holsinger; Meghan T Turner Journal: Laryngoscope Date: 2020-02-28 Impact factor: 3.325
Authors: Eric J Moore; Kathryn M Van Abel; Daniel L Price; Christine M Lohse; Kerry D Olsen; Ryan S Jackson; Eliot J Martin Journal: Head Neck Date: 2018-01-12 Impact factor: 3.147
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