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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Salvage Surgery for Recurrent Cancers of the Oropharynx: Comparing TORS With Standard Open Surgical Approaches.
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Salvage Surgery for Recurrent Cancers of the Oropharynx: Comparing TORS With Standard Open Surgical Approaches.

机译：口咽癌复发的抢救手术：将TORS与标准开放式手术方法进行比较。

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摘要

IMPORTANCE Surgical salvage may be the only viable treatment option for recurrent tumors of the oropharynx. To our knowledge, there have been no published reports directly comparing the oncologic and functional outcomes of patients with recurrent oropharyngeal squamous cell carcinoma (SCC) treated with transoral robotic-assisted surgery (TORS) with those treated with traditional open surgical approaches. OBJECTIVE To compare the oncologic and functional outcomes of patients with recurrent oropharyngeal SCC treated with TORS with those treated with traditional open surgical approaches. DESIGN Retrospective multi-institutional case-control study; study dates, March 2003 through October 2011. SETTING Four tertiary care institutions (University of Alabama at Birmingham; M. D. Anderson Cancer Center, Houston, Texas; Mayo Clinic, Rochester, Minnesota; and Henry Ford Hospital, Detroit, Michigan). PARTICIPANTS Sixty-four patients who underwent salvage TORS for recurrent oropharyngeal SCC were matched by TNM stage to 64 patients who underwent open salvage resection. INTERVENTION OR EXPOSURE Salvage TORS for recurrent SCC of the oropharynx. MAIN OUTCOME AND MEASURES Patient demographics, operative data, functional, and oncologic outcomes were recorded and compared with a similarly TNM-matched patient group that underwent salvage surgical resection by traditional open surgical approaches. RESULTS Patients treated with TORS were found to have a significantly lower incidence of tracheostomy use (n?=?14 vs n?=?50; P??.001), feeding tube use (n?=?23 vs n?=?48; P??.001), shorter overall hospital stays (3.8 days vs 8.0 days; P??.001), decreased operative time (111 minutes vs 350 minutes; P??.001), less blood loss (49 mL vs 331 mL; P??.001), and significantly decreased incidence of positive margins (n?=?6 vs n?=?19; P?=?.007). The 2-year recurrence-free survival rate was significantly higher in the TORS group than in the open approach group (74% and 43%, respectively) (P?=?.01). CONCLUSIONS AND RELEVANCE This study demonstrates that TORS offers an alternative surgical approach to recurrent tumors of the oropharynx with acceptable oncologic outcomes and better functional outcomes than traditional open surgical approaches. This adds to the growing amount of clinical evidence to support the use of TORS in selected patients with recurrent oropharyngeal SCC as a feasible and oncologically sound method of treatment.
机译：重要信息外科手术抢救可能是复发性口咽肿瘤的唯一可行治疗选择。据我们所知，尚无已发表的报告直接比较经口机器人辅助手术（TORS）与传统开放手术方法治疗的复发性口咽鳞状细胞癌（SCC）患者的肿瘤学和功能结局。目的比较经TORS治疗的复发性口咽SCC患者与传统开放手术方法的患者的肿瘤学和功能结局。设计回顾性多机构病例对照研究;研究日期为2003年3月至2011年10月。设置四个三级护理机构（阿拉巴马大学伯明翰分校;德克萨斯州休斯敦安德森医学中心;明尼苏达州罗切斯特市梅奥诊所;密歇根州底特律亨利福特医院）。研究对象64例因复发性口咽SCC接受TORS抢救的患者在TNM分期中与64例进行了开放抢救切除术的患者相匹配。干预或暴露口咽复发性SCC的抢救性TORS。主要结果和措施记录患者的人口统计学资料，手术数据，功能和肿瘤学结局，并与相似的TNM匹配患者组进行比较，该组患者通过传统的开放手术方法进行了挽救性手术切除。结果发现使用TORS的患者气管切开术的发生率显着较低（n = 14，v = 50; P <0.001），饲管使用率（n = 23，n = 23）。 ？48; P 。001），住院时间更短（3.8天vs 8.0天; P 。001），手术时间减少（111分钟vs 350分钟; P 。001），血液较少损失（49 mL比331 mL; P 。001），并且正切缘的发生率显着降低（n？=？6 vs n？=？19; P？= ?. 007）。 TORS组的2年无复发生存率显着高于开放治疗组（分别为74％和43％）（P≥0.01）。结论与相关性本研究表明，TORS为复发性口咽肿瘤提供了另一种手术方法，与传统的开放式手术方法相比，具有可接受的肿瘤学结局和更好的功能结局。这增加了越来越多的临床证据来支持在部分复发性口咽SCC患者中使用TORS作为可行且在肿瘤学上合理的治疗方法。

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