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Improving Head and Neck Cancer Outcomes

Joe Cantlupe, for HealthLeaders Media, January 8, 2011
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Haraf says there was a 70% chance that the patient would be cured. “Why sacrifice an organ [such as a tongue], if it doesn’t compromise your life?” he asked. As the team evaluates its care, it works to “ease up on patient suffering.” An evaluation of radiation techniques always occurs, to limit exposure and curtail toxicity, he says.

Success Key No. 2: Robotic surgery
While hospitals are launching transoral robotic surgery under the da Vince surgical system for many ailments, hospital officials say that the new technique is particularly important for head and neck care.
The system provides for improved surgical outcomes by using greater visualization techniques and improved precision, as well as quicker discharges for patients.

Physicians at St. Vincent Hospital use the da Vinci robotic surgical system, which avoids the use of the traditional, physically disfiguring surgery of opening the face and jawbone to realize the tumor. Patients are now discharged in less than five days as opposed to multiple weeks of inpatient recovery from the traditional surgery, according to Huntley.

While nonsurgical options can lead to side effects such as a lifelong dependence on a feeding tube, with the da Vinci procedure, that risk is less than 5%.

In 2009, the Food and Drug Administration approved the TORS process to remove malignant and benign tumors of the mouth, tongue, tonsils, and parts of the throat. Physicians maneuver the da Vinci’s robotic arms in the throat to remove the tumors. 

Side effects of radiation—dry mouth, loss of taste, and difficulty swallowing—can potentially be avoided with TORS. Unlike the traditional approaches to head and neck cancer, TORS patients are able to return to their normal lives only a few days after surgery without significant pain and disfigurement.

Some other benefits of TORS include less blood loss, no visible scarring, possibility of avoiding a tracheotomy, minimization or elimination of the need for chemoradiation therapy, fewer complications, shorter hospital stay, and faster recovery and return to normal speech and swallowing.

 Huntley and other practitioners who use the technique have called the new process “truly a paradigm shift” in the way head and neck cancer patients are treated. He adds, “Having this capability to remove a throat cancer tumor without any external incisions is paramount for the modern head and neck surgeon.
“With transoral robotic surgery, we can do great things—removing the tumor, getting it all maintained,” says Huntley. “When we think less invasively, it’s a benefit that people can heal faster and they are going to function better in the long term. It doesn’t have the drawback of the bigger surgery.

“TORS allows surgeons to completely remove tumors of the head and neck while preserving speech, swallowing, and other key quality-of-life issues such as eating. There also is no visible scarring or disfigurement. TORS patients may still need postoperative treatments, but the technique allows us to lessen the radiation dose to the sensitive throat muscles and lessen the need for feeding tubes and so improve quality of life.”

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