Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins.

Academic Article


  • 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.
  • Published In

  • Laryngoscope  Journal
  • Keywords

  • Aged, Carcinoma, Squamous Cell, Clinical Trials as Topic, Cooperative Behavior, Endoscopy, Feasibility Studies, Female, Follow-Up Studies, Head and Neck Neoplasms, Humans, Hypopharyngeal Neoplasms, Interdisciplinary Communication, Laryngeal Neoplasms, Length of Stay, Male, Middle Aged, Mouth Neoplasms, Neck Dissection, Neoplasm Staging, Oropharyngeal Neoplasms, Papilloma, Papillomavirus Infections, Postoperative Complications, Prospective Studies, Robotics, Squamous Cell Carcinoma of Head and Neck, Time and Motion Studies, Tracheostomy
  • Digital Object Identifier (doi)

    Author List

  • Weinstein GS; O'Malley BW; Magnuson JS; Carroll WR; Olsen KD; Daio L; Moore EJ; Holsinger FC
  • Start Page

  • 1701
  • End Page

  • 1707
  • Volume

  • 122
  • Issue

  • 8