Incisionless Robotic Surgery Benefits Oropharyngeal Cancer Treatment

TransOral Robotic Surgery (TORS), alone or in conjunction with chemotherapy or radiation may offer oropharyngeal cancer patients good outcomes and survival, according to a new study.

Researchers at Henry Ford Hospital (Detroit, MI, USA) conducted a retrospective study that included 53 oropharyngeal cancer patients (83% male, 77% Caucasian, mean age 60.8 years) who underwent TORS for cancer at the base of tongue, tonsils, soft palate, or pharynx. Among them, 37% underwent TORS alone, 11.4% received additional radiation therapy, and 50% received both chemotherapy and radiation therapy. The majority of patients (63%) were able to receive a lower dose of radiation after TORS, which reduces the risk of radiation side effects.

The researchers identified that 81% of the patients were positive to p16, a marker for human papilloma virus (HPV). When three-year survival, cancer control, and metastasis results were reviewed, patients that were negative to the p16 marker had 100% survival and low cancer recurrence when TORS was the first line of treatment, as well as when TORS was followed by chemotherapy and/or radiation therapy. The study was presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) annual meeting, held during September 2016 in San Diego (CA, USA).

“For non-surgical patients, several studies have shown that p16 positive throat cancers, or HPV- related throat cancers, have better survival and less recurrence than p16 negative throat cancers,” said lead author Tamer Ghanem, MD, PhD, director of head and neck oncology and reconstructive surgery at Surgery at Henry Ford Hospital. “Within our study, patients treated with robotic surgery had excellent results and survival, irrespective of their p16 status.”

TORS is a group of minimally invasive robotic surgery techniques that enable surgeons to remove benign and malignant tumors within the parapharyngeal space, a pyramid-shaped area that lies near the base of the skull and connects several deep compartments of the head and neck. It is lined with many large blood vessels, nerves and complex facial muscles, making access to the space via traditional surgical options often impossible or highly invasive. TORS is performed through the patient's mouth, resulting in shorter, virtually scarless head and neck surgery.

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