Clinical outcomes of transoral robotic-assisted surgery for the management of head and neck cancer

Figures & data

Figure 1 Flow diagram of included studies.

Abbreviations: HNSCC, head and neck squamous cell carcinoma; TORS, transoral robotic surgery.

Table 1 Perioperative and postoperative events for oropharynx studies

Author	N	Need for flap	LOS (d)	Primary site bleed	Neck hematoma	Pharyngo-cutaneous fistula	Positive margins	T racheostomy	GT
Weinstein et al,^Citation15 UPenn	47	NS	NS	0	0	0	1	3 (decanulated), 2 postop (1 long term)	NS (1 long term)
Genden et al,^Citation10 Mt Sinai	31	25 local, 6 free flap	NS	0		0	6	6 planned, 1 postop	7 during RT (0 long term)
Leonhardt et al,^Citation15 UPenn	38	NS	NS	NS	NS	NS	NS	1 (decannulated)	15 during RT (1 longterm)
Sinclair et al,^Citation5 UAB	42	0		NS	NS	NS	4	0	9 during RT (0 long term)
Moore et al,^Citation14 Mayo	66	NS	NS	1 (cautery in OR)	0	4		17 planned (all decanulated), 1 in CRT (long term)	2 before RT, 16 during (3 long term)
Weinstein et al,^Citation13 UPenn	30	NS	3.6	2	0	0		1 (decannulated)	0
Al-Khudari et al," Henry Ford	22	9 free flap	4.3	NS	NS	NS	NS	5 (all decannulated)	10 during RT (6 long term)
Dziegielewski et al,^Citation12 OSU	81	1 local	3.7	0	3 (drained in OR)	0	8	1 (decannulated)	1 preop, 17 in RT (10 longterm)
White et al,^Citation8 multiple	64	0	3.8	7	0	0	6	14 (3 preop)	23 (10 preop, 2 long term)
Dabas et al,^Citation7 India	60	0	4.2	5 (1 death, 3 back to OR)	0	0	2 (2 close)	NS	2 (0 long term)
Lee et al,^Citation5 Korea	27	0	14.6	0	0	0		16 (all decannulated)	0
Van Loon et al,^Citation6 the Netherlands	18	0	1.5		0	0	4 (2 close)	NS (1 long term)	NS (2 long term)
Choby et al,^Citation20 UPitt	34	NS	NS	NS	NS	NS	NS	0	2 (0 long term)

Abbreviations: CRT, concurrent chemotherapy and radiation; d, day; GT, gastrostomy tube; LOS, length of stay; Mayo, Mayo Clinic, Rochester; NS, not stated; OR, operating room; OSU, Ohio State University; RT, radiation therapy; UPenn, University of Pennsylvania; UAB, University of Alabama, Birmingham; UPitt, University of Pittsburgh.

Table 2 Oncologic outcomes for oropharynx studies

Author	Stage (neck dissection)	Adjuvant therapy	Follow up	2 y local control	2 y regional control	2 y loco-regional control	2 y distant control	2 y disease-specific survival	2 y disease-free survival	2 y overall survival
Weinstein et al,^Citation15 UPenn	Stage III–IV (100% ND)	28% RT, 64% CRT	Mean 26.6 m	98 (18 m)	96 (18 m)	NS	91 (18 m)	90	79	82
Leonhardt et al,^Citation15 UPenn	Stage I–IV (84% ND)	58% RT, 18% CRT	Mean 15.2 m	100 (15 m)	100 (15 m)	100 (15 m)	100 (15 m)	100 (15 m)	100 (15 m)	100 (15 m)
Moore et al,^Citation14 Mayo	Stage I–IV (100% ND)	21% RT, 62% CRT	Min 2 y	97 (3 y)	94 (3 y)	NS	98 (3 y)	95 (3 y)	95 (92 at 3 y)	95
Weinstein et al,^Citation13 UPenn	Stage I–IV (100% ND)	None	Mean 2.7 y	97 (18 m)	90 (18 m)	87 (18 m)	100% (18 m)	100 (18 m)	87 (18 m)	100 (18 m)
Dziegielewski et al,^Citation12 OSU	Stage I–IV (98% ND)	25% RT, 62% CRT	Mean 22.7 m	NS	NS	NS	NS	92 (89 at 4 y)	NS	NS
White et al,^Citation8 multiple	All salvage	NS	NS	NS	NS	NS	NS	NS	73	NS
Carpenter et al,^Citation24 Mt Sinai	Stage I–IV (100% ND)	39% RT, 61% CRT	Median 17.5 m	NS	NS	93	96	NS	NS	97
Dabas et al,^Citation7 India	Stage I–IV (100% ND)	39% RT, 20% CRT	Mean 8 m	NS	NS	NS	NS	NS	64 (18 m)	93 (18 m)
Ford et al,^Citation23 UAB	Stage I–IV (86% ND)	66% RT, 26% CRT	NS	NS	NS	NS	NS	NS	91 (89 at 3 y)	NS
Lee et al,^Citation5 Korea	T1–T3 (100% ND)	CRT based on path	Mean 20.3 m	100	100	100	95.7	100	95.7	100
Van Loon et al,^Citation6 the Netherlands	T1–T2 (50% ND)	22% RT	Median 36 m	100	88.9	88.9	100	100	88.9	94.4
Choby et al,^Citation20 UPitt	Stage I–IV	None	Mean 14 m	NS	NS	NS	NS	97 (14 m)	94 (14 m)	94 (14 m)

Abbreviations: CRT, concurrent chemotherapy and radiation therapy; Mayo, Mayo Clinic, Rochester; ND, neck dissection; m, months; NS, not stated; OSU, Ohio State University; RT, radiation therapy; UPenn, University of Pennsylvania; UAB, University of Alabama, Birmingham; UPitt, University of Pittsburgh; y, year.

Table 3 Perioperative and postoperative events and oncologic outcomes for larynx studies

Author	N	Subsite	Stage (neck dissection)	LOS (d)	Complications	Tracheostomy	GT	Positive margins	Follow up (m)	Adjuvant therapy	2y survival
Kayhan et al,^Citation36 Turkey	10	G	T1 (0% ND)	Mean 4.1	1 tracheotomy	1 post op	0, Swallow mean 1 d	None	9.1 m	None	NS
Mendelsohn et al,^Citation25 UCLA	18	SG	T1–T2 (50% ND)	Median 11	5 complications	None	0, Swallow median 4.5 d	NS	28.1 m	55.6% CRT	100% DSS 88.9% OS
Olsen et al,^Citation33 Mayo	9	SG	T1–T3 (100% ND)	NS	No acute, 1 SG stenosis, 1 trach bleed	7 planned, 5 decannulated	4 post op 2 depend	None	26 m	44% RT 22% CRT	87.5% DSS 66.7% OS
Ozer et al,^Citation34 OSU	13	SG	T1–T3 (84.6% ND)	Mean 3.9 d	No acute, 1 tracheotomy	1 post op	1 GT, 1 NGT	None	6.8 m	15.4% RT	NS
Ansarin et al,^Citation37 Italy	10	SG	T1–T3 (40% ND)	Mean 13 d	1 GT	None	1 GT	4 positive	25 m	20% RT 50% CRT	100% DSS 100% OS
Lallemant et al,^Citation35 France	23	SG (10) G (13)	T1–T2 SG (100% ND), G (7% ND)	SG median 13 d G median 5 d	SG: 1 post op bleed G: 1 post op bleed and pneumothorax	2 pre op, 1 post op, all decannulated	1 GT	4 close, 1 positive, 4 NS	15.7 m	8.6% RT 8.6% CRT	NS
Oysu and Sahin-Yilmaz,^Citation32 Turkey	3	SG	T1 (66% ND)	NS	None	None	0, Swallow mean 8.3 d	None	14 m	66% RT	NS
Park et al,^Citation38 Korea	17	SG	T1-T3 (88.2% ND)	Mean 18.6 d	1 Laryngeal stenosis	None	0, Swallow mean 8.1 d	17.6%	27.3 m	47% RT	92% DFS 92% OS
Kayhan et al,^Citation31 Turkey	13	SG	T1-T2 (100% ND)	Mean 15.4 d	No acute, 3 tracheotomy, 1 laryngeal stenosis	3 post op	0, Swallow mean 10.8 d	None	14.5m	38.5% CRT	NS

Abbreviations: CRT, concurrent chemotherapy and radiation therapy; d, day; DFS, disease-free survival; DSS, disease-specific survival; LOS, length of stay; Mayo, Mayo Clinic, Rochester; NS, not stated; op, operative; OS, overall survival; OSU, Ohio State University; RT, radiation therapy; UCLA, University of California, Los Angeles; y, year; GT, gastrostomy tube; NGT, nasogastric tube; ND, neck dissection; G, glottis; SG, supraglottis.

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