Functional Outcomes After Transoral Robotic Surgery for Head and Neck Cancer

Otolaryngol Head Neck Surg. 2009 Aug;141(2):166-71. doi: 10.1016/j.otohns.2009.05.014.

Abstract

Objective: To evaluate functional outcomes following transoral robotic surgery for head and neck cancer.

Study design: Case series with planned data collection.

Setting: Academic hospital.

Subjects and methods: Between March 2007 and December 2008, 54 of 62 candidate patients underwent transoral robotic tumor resection. Outcomes include airway management, swallowing (MD Anderson Dysphagia Inventory), and enterogastric feeding.

Results: Tumors were most commonly oropharynx (61%) or larynx (22%) and T1 (35%) or T2 (44%). Many received radiotherapy (22% preoperatively, 41% postoperatively) and chemotherapy (31%). Endotracheal intubation was retained (22%) for up to 48 hours, tracheostomy less frequently (9%), and all were decannulated by 14 days. Most commenced oral intake prior to discharge (69%) or within two weeks (83%). A worse postoperative Dysphagia Inventory score was associated with retained feeding tube (P=0.020), age>60 (P=0.017), higher T stage (P=0.009), laryngeal site (P=0.017), and complications (P=0.035). At a mean 12 months' follow-up, 17 percent retained a feeding tube (9.5% among primary cases). Retained feeding tube was associated with preoperative tube requirement (P=0.017), higher T stage (P=0.043), oropharyngeal/laryngeal site (P=0.034), and recurrent/second primary tumor (P=0.008). Complications including airway edema (9%), aspiration (6%), bleeding (6%), and salivary fistula (2%) were managed without major sequelae.

Conclusion: Transoral robotic surgery provides an emerging alternative for selected primary and salvage head and neck tumors with low morbidity and acceptable functional outcomes. Patients with advanced T stage, laryngeal or oropharyngeal site, and preoperative enterogastric feeding may be at increased risk of enterogastric feeding and poor swallowing outcomes.

Trial registration: ClinicalTrials.gov NCT00473564.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chemotherapy, Adjuvant
  • Deglutition
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / drug therapy
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy
  • Head and Neck Neoplasms / surgery*
  • Hemorrhage / prevention & control
  • Hospitals, University
  • Humans
  • Intubation, Intratracheal / methods
  • Laryngeal Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Oral Surgical Procedures / methods*
  • Oropharyngeal Neoplasms / surgery
  • Prospective Studies
  • Radiotherapy, Adjuvant
  • Risk Factors
  • Robotics*
  • Salvage Therapy

Associated data

  • ClinicalTrials.gov/NCT00473564