Transoral Robotic-assisted Surgery For Head And Neck Squamous Cell Carcinoma: 5-year Survival Analysis

Presentation: S346
Topic: Oropharynx
Type: Oral
Date: Tuesday, July 19, 2016
Session: 1:30 PM - 3:00 PM Metastasis
Authors: Julia A Crawford, MBBS, FRACS1, Hilliary N White, MD2, Thomas K Chung, MD3, Eric J Moore, MD4, Ryan Jackson, MD5, Lauren Kendall6, William Carroll, MD3, Eben Rosenthal, MD7, J Scott Magnuson, MD8
Institution(s): 1St Vincent's Hospital, Sydney, 2Baptist Medical Group, 3University of Alabama Birmingham, 4Mayo Clinic Rochester, 5Washington University, 6University of Central Florida, 7Stanford Cancer Center, 8Florida Hospital
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Background: The shift in epidemiology of oropharyngeal squamous cell carcinoma (OPSCC) from a predominantly older population with a strong tobacco and alcohol history to a younger subset of patients without these traditional risk factors but who are HPV positive has led to a desire to find alternative pathways to treatment rather than the traditional organ preserving chemo-radiation. One of the alternative treatment strategies that produced growing interest is trans-oral robotic surgery (TORS). Here we present the follow up 5-year survival data from two in institutions who implemented the use of TORS for treatment of upper aero-digestive tract malignancy early in the evolution of this treatment strategy. The 1 and 2-year survival of these same patients was previously presented and published.

Methods: Eighty-nine patients from two tertiary care centers (University of Alabama at Birmingham and the Mayo Clinic in Rochester, Minnesota) with head and neck squamous cell carcinoma of the oropharynx, who underwent transoral robotic-assisted resection between March 2007 and December 2008, with a total follow up time of no less than 5 years were analyzed for disease-free survival, cancer recurrence and gastrostomy tube dependence.

Results: Seventy-one patients had T1 (n=29) or T2 (n = 42) tumors while 18 patients had T3 (n = 8) or T4(n = 10) tumors. There were 24 patients with overall stage I or II disease and 65 with stage III or IV disease. Overall survival at 5 years was 89%. Recurrence free survival was 82% at five years. Survival was not statistically signficantly affected by HPV status although 14 patients (18%) were unknown which is likely to have contributed to this outcome. Locoregional recurrence was increased in patients who continued to smoke and those with postive margins. Only five patients (7%) had a PEG tube at last follow up.

Conclusions: The 5-year functional and oncologic results justify the continued treatment of select patients with head and neck squamous cell carcinoma with robotic assisted surgical resection.

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