8/18Transoral Robotic Surgery
TRANSORAL ROBOTIC SURGERY
Cameron D. Godfrey, M.D. Otolaryngology (ENT)
Transoral robotic surgery allows access to the oropharynx without the pain and side effects of traditional surgery. It often allows patients to avoid chemotherapy and radiation. Improved quality of life is the goal.
CASE STUDY: Modified Neck Dissection and Radical tonsillectomy with Partial Glossectomy using Transoral Robotic Surgery (TORS).
The patient is a 56-year-old male, nonsmoker, who presented in September 2013 with a two-month history of a sore throat not responsive to three rounds of antibiotics. An exam showed an asymmetric right tonsil. Palpation revealed a firm nodule and a subsequent biopsy identified squamous cell carcinoma.
The patient then underwent modified neck dissection and radical tonsillectomy with partial glossectomy using transoral robotic surgery (TORS). The function of the robot proved to be beneficial and, not only in this patient but others as well, left for much less chance of needing NG tubes and gastrostomy tubes than patients who underwent previous type surgery or chemotherapy and radiation.
Margins were clear, and there were no lymph nodes with metastatic cancer. With these pathology findings, chemotherapy and radiation were not recommended.
The postoperative course was without complication. The patient had the expected postoperative pain and difficulty swallowing, but did not require NG tube or PEG. He left the hospital several days after surgery on a liquid diet. By three weeks postop, his diet was progressing and he quickly was back to regular food. He returned to work four weeks postop. The PET scan three months after surgery was normal. He is now seven months out with no evidence of cancer. He will continue to be followed closely by his doctor.
Increasing at an Alarming Rate
Cancer of the oropharynx (tonsil, base of tongue, soft palate, and posterior pharyngeal wall) is increasing at an alarming rate. Approximately 12,000 new cases of these squamous cell cancers are diagnosed in the U.S. every year. In the past, the major risk factors were smoking and alcohol use. In the last 20 years, infection with papilloma virus has been recognized as an additional independent risk factor in nonsmokers and nondrinkers. Recent publications have reported that 70-90% of oropharyngeal cancers are now HPV positive. Most of these are HPV-16.
HPV-positive oropharyngeal cancer is more common in Caucasians and Hispanics than African-Americans. It is more frequent in males than females. It is also seen in a younger population than the smoking-related HPV-negative cancers. The prognosis for HPV-positive cancers is much better than the HPV-negative cancers.
The two vaccines approved by the FDA protect against HPV infections causing cervical cancer in women and also oropharyngeal cancer. Recent publications from the CDC have shown these vaccines could prevent most oropharyngeal cancers in the U.S. It is now recommended for both boys and girls (up to age 26).
A publication from the Vice President of Quality/Chief Medical Officer at United Regional, Summer 2014
Posted by: Jed Grisel