Author(s)
Ryan Jin, BS
Amar D. Desai, MPH
Salma Ahsanuddin, BS
Kirolos Georges, BS
Soly Baredes, MD
Richard Chan Woo Park, MD
Affiliation(s)
Rutgers New Jersey Medical School;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand use of transoral robotic surgery and endoscopy has changed in the management of oropharyngeal malignancies over time.
Objectives: Transoral robotic surgery (TORS) offers an alternative approach to the management of oropharyngeal malignancies, increasing access to regions otherwise inaccessible. We assess trends in utilization of TORS compared to open and endoscopic resection in T1/T2 base of tongue and tonsillar squamous cell carcinoma (SCC).
Study Design: Retrospective analysis of a national cancer registry.
Methods: The 2010-2016 National Cancer Database was queried for all cases of T1/T2 tonsillar and base of tongue SCC. Surgical management was stratified based on TORS, endoscopic, or open approaches. Kaplan-Meier, and Cox multivariable survival analyses were performed to determine differences in clinicopathologic characteristics and outcomes between the groups.
Results: 11311 cases of T1/T2 tonsil and base of tongue SCC were identified of which 6975 (61.7%) were performed via open approach, 747 (6.6%) were performed endoscopically, and 3589 (31.7%) were performed via TORS. Tonsils comprised 8910 (78.8%) of all cases with most cases being performed via open resection with 5646 (63.4%) cases or TORS with 2710 (30.4%) cases. Use of TORS significantly increased from 2010 to 2016 while use of endoscopic and open resection significantly decreased (p<0.001). TORS was significantly protective against positive margins (OR 0.65, p<0.001) and resulted in a significantly higher 5 year overall survival (TORS: 78.6% vs open: 75.9% vs endoscopic: 74.2%, p=0.008). On Cox multivariable survival analysis, TORS resulted in a significantly lower hazard of death (HR 0.87, p=0.020) compared to open surgery.
Conclusions: Utilization of TORS in T1/T2 oropharyngeal SCC has increased significantly from 2010 to 2016 and confers significantly improved survival compared to open and endoscopic approaches.