Transoral robotic surgery: a 4-year learning experience in a single Danish Cancer Centre

Abstract

Background: The main indication for transoral robotic surgery (TORS) has been the primary treatment of oropharyngeal squamous cell carcinoma (OPSCC). In the western world this is highly relevant due to the increasing incidence of human papillomavirus (HPV)-positive OPSCC. In Denmark, TORS was implemented in 2013 for use in the protocolled primary treatment of OPSCC.

Aims/objectives: To perform a year-by-year comparative analysis of indications for TORS, hospitalization and complication rates to identify optimal future indications for TORS.

Methods and materials: This is a retrospective single-centre case review from 2013-2017. Data were collected from patient files through electronic health care systems.

Results: Since 2013, there has been a change of indications from performing benign and salvage surgery to mainly primary treatment of OPSCC and diagnostic use in patients with cancer of unknown primary (CUP). The overall complication rates have reduced considerably over time.

Conclusions and significance: Lower complication rates may be explained by improved surgical experience, through better patient selection and changes in indications for TORS. Future applications of TORS will be in the management of CUP and as part of a Danish national randomized clinical trial aiming to compare long-term functional outcomes after treatment of early-stage OPSCC with TORS versus radiation treatment.

Chinese abstract

背景：经口机器人手术（TOR）主要适用于口咽鳞状细胞癌（OPSCC）的初步治疗。在西方世界, 这一点非常重要, 因为这里人乳头状瘤病毒（HPV）阳性OPSCC的发病率不断增加。丹麦于 2013年开始实施TOR, 用于OPSCC的原发性治疗。

目的：对TOR的适用性、住院率和并发症发生率进行逐年对比分析, 以确定TOR的最佳未来适用症。

方法与材料：回顾性分析2013-2017年单中心病例。数据是通过电子医疗系统从病人档案中收集的。

结果：自2013年以来, 适用症发生了变化, 从良性和挽救性手术转变为以OPSCC为主的一期治疗和诊断不明原因原发性肿瘤（CUP）。随着时间的推移, 总的并发症发生率已大大降低。

结论和意义：通过更好的患者选择和TOR适用症的改变, 从而改善手术过程, 这是较低并发症发生率的原因。TORS的未来应用将在CUP的治疗中, 并用于丹麦国家随机临床试验的一部分。该试验旨在比较用TORS和用肿瘤学疗法治疗早期OPSCC后的长期功能结果。

Keywords:

• Transoral robotic surgery
• oropharyngeal cancer
• unknown primary
• HPV
• complications indications learning curve

Disclosure statement

The authors report no conflicts of interest.