Author(s): Weinstein GS, OMalley BW Jr, Magnuson JS, Carroll WR, Olsen KD,
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Abstract OBJECTIVES/HYPOTHESIS: Our objective was to determine the safety, feasibility, and the adequacy of surgical margins for transoral robotic surgery (TORS), by reviewing the early results from independent institutional review board-approved clinical trials in three separate institutions. STUDY DESIGN: Pooled Data from Independent Prospective Clinical Trials. METHODS: One hundred ninety-two patients were initially screened, but inadequate exposure did not permit TORS in 13 (6.7\%). For two additional patients, TORS was begun but intraoperatively converted to an open procedure. Thus, the intent-to-treat population was 177 patients (average age, 59 years; 81\% male), predominantly comprised of tumors arising in the oropharynx (139, 78\%) and larynx (26, 15\%). TORS was performed for 161 (91\%) patients with malignant disease: 153 (95\%) with squamous cell carcinoma (T1 [50, 32.7\%], T2 [74, 48.4\%], T3 [21, 13.7\%], T4 [8, 5.2\%]), six patients (3.72\%) with salivary gland tumors, and two patients with carcinoma in situ. The average follow-up was 345 days. RESULTS: There was no intraoperative mortality or death in the immediate postoperative period. Average estimated blood loss was 83 mL; no patient required transfusion. The rate of positive margins was 4.3\%. Twenty-nine patients (16\%) experienced 34 serious adverse events that required hospitalization or intervention (grade 3) or were considered life threatening (grade 4, 2.3\%). Tracheostomy was performed in 12.4\% of all patients (22/177), but only 2.3\% had a tracheostomy at last follow-up. For all patients undergoing TORS without previous therapy, the percutaneous endoscopic gastrostomy dependency rate was 5.0\%. The average hospital stay was 4.2 days. CONCLUSIONS: Based on this multicenter study, TORS appears to be safe, feasible, and as such play an important role in the multidisciplinary management of head and neck cancer. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
This article was published in Laryngoscope
and referenced in Advances in Robotics & Automation