Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Salvage Transoral Robotic Surgery for Recurrent or Residual Head and Neck Squamous Cell Carcinoma: A Single Institution Experience

  • Dabas, Surender (Department of Surgical Oncology, Rajiv Gandhi Cancer Institute) ;
  • Dewan, Abhinav (Department of Radiation Oncology, Rajiv Gandhi Cancer Institute) ;
  • Ranjan, Reetesh (Department of Surgical Oncology, Rajiv Gandhi Cancer Institute) ;
  • Dewan, Ajay Kumar (Department of Surgical Oncology, Rajiv Gandhi Cancer Institute) ;
  • Shukla, Himanshu (Department of Surgical Oncology, Rajiv Gandhi Cancer Institute) ;
  • Sinha, Rupal (Department of Research, Rajiv Gandhi Cancer Institute)
  • Published : 2015.12.03
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Abstract

Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.

Keywords

References

  1. Bachar GY, Goh C, Goldstein DP, et al (2010). Long term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol, 267, 295-301. https://doi.org/10.1007/s00405-009-1070-0
  2. Boudreaux BA, Rosenthal EL, Magnuson JS, et al (2009). Robotassisted surgery for upper aerodigestive tract neoplasms. Arch Otolaryngol Head Neck Surg, 135, 397-401. https://doi.org/10.1001/archoto.2009.24
  3. Chen AY, Schrag N, Hao Y, et al (2007). Changes in treatment of advanced oropharyngeal cancer, 1985-2001. Laryngoscope, 117, 16-21. https://doi.org/10.1097/01.mlg.0000240182.61922.31
  4. Clark JR, De Almedia J, Gilbert R, et al (2006). Primary and salvage (hypo) pharyngectomy: analysis and outcome. Head Neck, 28, 671-7. https://doi.org/10.1002/hed.20428
  5. Genden EM, Desai S, Sung CK (2009). Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck, 31, 283-9. https://doi.org/10.1002/hed.20972
  6. Genden EM, Desai S, Sung CK (2009). Transoral robotic surgery for the management of Head Neck, 31, 283-9. https://doi.org/10.1002/hed.20972
  7. Jackel MC, Ambrosch P, Martin A, et al (2007). Impact of reresection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope, 117, 350-6. https://doi.org/10.1097/01.mlg.0000251165.48830.89
  8. Joseph DL, Shumrick DL (1973). Risks of head and neck surgery in previously irradiated patients. Arch Otolaryngol, 97, 381-4. https://doi.org/10.1001/archotol.1973.00780010393005
  9. Ketcham AS, Hoye RC (1965). Spontaneous carotid artery hemorrhage after head and neck surgery. Am J Surg, 110, 649-55. https://doi.org/10.1016/0002-9610(65)90055-3
  10. Kostrzewa JP, LancasterWP, Iseli TA, et al (2010). Outcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope, 120, 267-272.
  11. Moore EJ, Henstrom DK, Olsen KD, et al (2009). Transoral resection of tonsillar squamous cell carcinoma. Laryngoscope, 119, 508-15. https://doi.org/10.1002/lary.20124
  12. Moore EJ, Olsen KD, Kasperbauer JL (2009). Transoral robotic surgery for oropharyngeal squamous cell carcinoma: A prospective study of feasibility and functional outcomes. Laryngoscope, 119, 2156-64. https://doi.org/10.1002/lary.20647
  13. Moore EJ, Olsen KD, Kasperbauer JL (2009). Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope, 119, 2156-64. https://doi.org/10.1002/lary.20647
  14. O'Brien CJ, Nettle WJ, Lee KK (1993). Changing trends in the management of carcinoma of the oral cavity and oropharynx. Aust N Z J Surg, 63, 270-4. https://doi.org/10.1111/j.1445-2197.1993.tb00381.x
  15. Preuss SF, Cramer K, Klussmann JP, et al (2009). Transoral laser surgery for laryngeal cancer: outcome, complications and prognostic factors in 275 patients. Eur J Surg Oncol, 35, 235-40. https://doi.org/10.1016/j.ejso.2008.01.012
  16. Rate WR, Garrett P, Hamaker R, et al (1991). Intraoperative radiation therapy for recurrent head and neck cancer. Cancer, 67, 2738-40. https://doi.org/10.1002/1097-0142(19910601)67:11<2738::AID-CNCR2820671104>3.0.CO;2-B
  17. Richey LM, Shores CG, George J, et al (2007). The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngol Head Neck Surg, 136, 98-103. https://doi.org/10.1016/j.otohns.2006.06.1267
  18. Roosli C, Studer G, Stoeckli SJ (2010). Salvage treatment for recurrent oropharyngeal squamous cell carcinoma. Head Neck, 32, 989-96.
  19. Shumrick DA (1973). Carotid artery rupture. Laryngoscope, 83, 1051-61. https://doi.org/10.1288/00005537-197307000-00006
  20. Sobol SM, Freeman R, Thawley S, et al (1982). Management of inadvertent injury to the carotid artery during head and neck surgery. Head Neck Surg, 4, 475-82. https://doi.org/10.1002/hed.2890040606
  21. Wakisaka N, Murono S, Kondo S, et al (2008). Post operative pharyngocutaneous fistula after laryngectomy. Auris Nasus Larynx, 35, 203-208. https://doi.org/10.1016/j.anl.2007.06.002
  22. Weber RS, Berkey BA, Forastiere A, et al (2003). Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg, 129, 44-49. https://doi.org/10.1001/archotol.129.1.44
  23. Weinstein GS, O'Malley BW Jr, Desai SC, et al (2009). Transoral robotic surgery: Does the ends justify the means? Curr Opin Otolaryngol Head Neck Surg, 17, 126-131. https://doi.org/10.1097/MOO.0b013e32832924f5
  24. Weinstein GS, O'Malley BW Jr, Magnuson JS, et al (2012). Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope, 122, 1701-7. https://doi.org/10.1002/lary.23294
  25. White H1, Ford S, Bush B, et al (2013). Salvage surgery for recurrent cancers of the oropharynx: comparing TORS with standard open surgical approaches. JAMA Otolaryngol Head Neck Surg, 139, 773-8. https://doi.org/10.1001/jamaoto.2013.3866
  26. Zafereo ME, Hanasono MM, Rosenthal DI, et al (2009). The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx. Cancer, 115, 5723-33. https://doi.org/10.1002/cncr.24595

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