Less-invasive robotic surgery for upper airway and digestive track malignant tumors is as effective as other minimally invasive surgical techniques based on patient function and survival, according to research published Dec. 20, 2010, in the Archives of Otolaryngology–Head & Neck Surgery.
Head and neck squamous cell carcinomas account for about 4% of malignant tumors diagnosed in the United States each year. Currently, the standard minimally invasive surgery for these tumors is transoral laser microsurgery.
Previous studies have shown that robotic surgery was better for patients to regain the ability to swallow; this one also addressed survival rates. Investigators looked at 89 patients with various stages of head and neck squamous cell carcinomas whose primary tumor was resected using the da Vinci Robot. They were monitored during their hospital stay and up to 33 months after surgery.
The overall two-year survival rate for these patients, 86.3%, is comparable to the standard treatment, according to lead author J. Scott Magnuson, MD, an otolaryngologist at the University of Alabama-Birmingham and scientist in the UAB Comprehensive Cancer Center. “Those with earlier-stage tumors appeared to have slightly better recurrence-free survival than those with later stages, but it was not statistically significant.”
Magnuson said swallowing varied depending on the location of the tumor, preoperative swallowing ability, cancer stage, and patient age; the findings on function were consistent with previous research. Moreover, he notes, all the patients in the study had regained full swallowing ability at the time of the last follow-up visit.
The results are encouraging, but more work needs to be done, say the authors. “The early functional and oncologic results justify the continued treatment of select patients with HNSCC [head and neck squamous cell carcinomas] with robotic-assisted surgeries.”
So how should a physician decide who would be an appropriate candidate? Magnuson defers to the FDA, explaining to HealthLeaders Media that the agency has approved transoral robotic-assisted surgery for patients with T1 and T2 cancers as well as those with benign tumors/disease.
Another study, also published in the Archives of Otolaryngology–Head & Neck Surgery, finds that most patients do not have ongoing speaking or swallowing difficulties following combined chemotherapy and radiation treatment for advanced head or neck cancer.
Kent W. Mouw, MD, then of the University of Chicago and now of Brigham and Women's Hospital, Boston, and colleagues studied patients who were successfully treated with chemoradiotherapy for advanced head and neck cancer. An average of 34.8 months after completing treatment, 163 patients were assigned a speaking score of one through four; 166 patients were assigned a swallowing score of one through four at an average of 34.5 months after treatment, with increasing scores correlating with decreasing function.
Most (84.7% of those with speaking scores and 63.3% of those with swallowing scores) had no lasting difficulties and were assigned a score of one. Of 160 patients who had both swallowing and speaking scores, 96 had a score of one in each category.
Factors that were associated with worse speaking scores were being female, having a history of smoking, having a tumor in the hypopharynx or in the larynx, or having a tumor that did not respond to the initial dose of chemotherapy.
Factors associated with worse swallowing scores included being older, having poor performance status (a measure of disability) before treatment, and neck dissection, with a trend toward worse scores in those with tumors in the hypopharynx and larynx.
“Because advances in therapy have led to improved survival in these patients, understanding and controlling adverse effects of treatment should continue to be an active area of investigation,” the authors conclude.