BACKGROUND: The aim of this observational prospective study was to determine the technical feasibility, safety and adequacy of surgical margins for transoral robotic surgery (TORS) in supraglottic cancers.
METHODS: From February 2014 to May 2016, 46 patients with supraglottic lesions underwent TORS with or without neck dissection using the da Vinci® Surgical system. Patients were observed and data recorded on surgical time, blood loss, complications and functional outcome of patients.
RESULTS: A total of 46 patients (44 males and 2 females) underwent TORS, with ipsilateral neck dissection performed in 40 of the patients and 12 patients underwent bilateral neck dissection. Mean age at presentation was 62.9 years. Thirty nine (84.8%) patients had a positive addiction history for tobacco or alcohol. All patients included in the study were prior treatment naïve patients. Most common site of primary was Arye-epiglottic fold in 22 (47.8%) patients, rest being epiglottis in 16 (34.8%) and Pharyngo-epiglottic fold in 6 (13%) patients. Twenty-two (47.8%) patients were cT1 and 24 (52.1%) were cT2 at presentation. All patients underwent Neck dissection first and TORS subsequently in the same sitting. Average Robotic set-up time was 8.8 min and average robotic operative time was 42.9 min. Average blood loss during surgery was 33 ± 15ml. Superior laryngeal artery ligation was done in 31 patients. One patient had to be converted to open because of difficulty in access due to trismus. A positive or close margin was seen in 12 patients (26%) on frozen, which were revised intra-operatively. On final histology 3 (6.5%) patients had margin < 5mm. Average closest margin on final histology was 6.2mm. Twenty four (52.1%) patients required tracheostomy, and 11 (23.9%) patients underwent percutaneous endoscopic gastrostomy for feeding. All except 3 patients were successfully decannulated after surgery. Six (13%) patients were dependent on long term Ryles tube/PEG feeding. Patients started tolerating oral feeds within two week of procedure (mean 13.4 days), with the nasogastric tube removed within two to three weeks post-op (mean 20 days). Of the 46 patients, 41 (89.1%) patients were HPV negative. Postoperative complications in the form of primary haemorrhage required active intervention in three patients. Postoperatively, all patients had adequate swallowing and speech function. Follow-up ranged from 7 to 32 months with an average follow-up of 18 months. One patient was lost to follow-up; 4 (8.7%) patients expired due to other causes. Four (8.7%) patients had locoregional recurrence on follow-up. Thirty seven (80.4%) of the patients are on regular follow-up with no evidence of disease and are doing well.
CONCLUSION: TORS is a safe, feasible, minimally invasive and oncologically safe procedure in patients with early supraglottic cancers. It has the least morbidity and offers benefits in terms of early airway and feeding rehabilitation and can avoid complications resulting from radiation therapy for these patients.