John C Hardman1, F Chris Holsinger2, Grainne C Brady3, Avinash Beharry4, Alec T Bonifer5, Gregoire D'Andréa6, Surender K Dabas7, John R de Almeida8, Umamaheswar Duvvuri9, Peter Floros10, Tamer A Ghanem5, Philippe Gorphe6, Neil D Gross11, David Hamilton12, Chareeni Kurukulasuriya9, Mikkel Hjordt Holm Larsen13, Daniel J Lin12, J Scott Magnuson10, Jeroen Meulemans14, Brett A Miles15, Eric J Moore16, Gouri Pantvaidya17, Scott Roof18, Niclas Rubek13, Christian Simon4, Anand Subash7, Michael C Topf19, Kathryn M Van Abel16, Vincent Vander Poorten14, Evan S Walgama11, Emily Greenlay20, Laura Potts20, Arun Balaji21, Heather M Starmer2, Sarah Stephen12, Justin Roe3, Kevin Harrington1, Vinidh Paleri1. 1. Head and Neck Unit, The Royal Marsden Hospital, London, UK. 2. Department of Otolaryngology-H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA. 3. Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK. 4. Department of Otolaryngology-H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland. 5. Department of Otolaryngology-H&N Surgery, Henry Ford Hospital, Detroit, MI, USA. 6. Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France. 7. Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India. 8. Department of Otolaryngology-H&N Surgery, University Health Network, Toronto, ON, Canada. 9. Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA. 10. Department of Otolaryngology-H&N Surgery, Florida Hospital Group, Celebration, FL, USA. 11. Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA. 12. Department of Otolaryngology-H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK. 13. Department of Head and Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark. 14. Otorhinolaryngology-Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium. 15. Department of Otolaryngology Head and Neck Surgery, Northwell Health System, New York, NY, USA. 16. Department of Otolaryngology-H&N Surgery, Mayo Clinic, Rochester, MN, USA. 17. Department of H&N Surgery, Tata Memorial Hospital, Mumbai, India. 18. Department of Otolaryngology, Mount Sinai Hospital, New York City, NY, USA. 19. Department of Otolaryngology-H&N Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 20. Clinical Trials Unit, The Royal Marsden Hospital, London, UK. 21. Department of H&N Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Abstract
BACKGROUND: Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness. METHODS: A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC. RESULTS: Data for 278 eligible patients were analyzed, with median follow-up of 38.5 months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0 mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0 mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0 mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n = 22 of 272), and 30-day mortality was 1.8% (n = 5 of 272). At 1 year, 10.8% (n = 21 of 195) used tracheostomies, 33.8% (n = 66 of 195) used gastrostomies, and 66.3% (n = 53 of 80) had maintained or improved normalcy of diet scores. CONCLUSIONS: Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting.
BACKGROUND: Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness. METHODS: A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC. RESULTS: Data for 278 eligible patients were analyzed, with median follow-up of 38.5 months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0 mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0 mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0 mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n = 22 of 272), and 30-day mortality was 1.8% (n = 5 of 272). At 1 year, 10.8% (n = 21 of 195) used tracheostomies, 33.8% (n = 66 of 195) used gastrostomies, and 66.3% (n = 53 of 80) had maintained or improved normalcy of diet scores. CONCLUSIONS: Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting.
Authors: K Kian Ang; Jonathan Harris; Richard Wheeler; Randal Weber; David I Rosenthal; Phuc Felix Nguyen-Tân; William H Westra; Christine H Chung; Richard C Jordan; Charles Lu; Harold Kim; Rita Axelrod; C Craig Silverman; Kevin P Redmond; Maura L Gillison Journal: N Engl J Med Date: 2010-06-07 Impact factor: 91.245
Authors: Samip N Patel; Marc A Cohen; Babak Givi; Benjamin J Dixon; Ralph W Gilbert; Patrick J Gullane; Dale H Brown; Jonathan C Irish; John R de Almeida; Kevin M Higgins; Danny Enepekides; Shao Hui Huang; John Waldron; Brian O'Sullivan; Wei Xu; Susie Su; David P Goldstein Journal: Head Neck Date: 2015-07-15 Impact factor: 3.147
Authors: John Hardman; ZiWei Liu; Grainne Brady; Justin Roe; Cyrus Kerawala; Francesco Riva; Peter Clarke; Dae Kim; Shreerang Bhide; Christopher Nutting; Kevin Harrington; Vinidh Paleri Journal: Head Neck Date: 2020-02-18 Impact factor: 3.147
Authors: Jeroen Meulemans; Christophe Vanclooster; Tom Vauterin; Emmanuel D'heygere; Sandra Nuyts; Paul M Clement; Robert Hermans; Pierre Delaere; Vincent Vander Poorten Journal: Front Oncol Date: 2017-02-09 Impact factor: 6.244