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Original Investigation
January 2018

Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer

Author Affiliations
  • 1Department of Head and Neck Surgery, Oregon Health and Science University, Portland
  • 2The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
  • 3Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
JAMA Otolaryngol Head Neck Surg. 2018;144(1):18-27. doi:10.1001/jamaoto.2017.1790
Key Points

Question  How does adjuvant radiotherapy with and without concomitant chemotherapy affect functional speech and swallowing outcomes and quality-of-life metrics in patients with squamous cell carcinoma of the oropharynx who have undergone transoral robotic surgery?

Findings  This longitudinal cohort study of 74 patients undergoing transoral robotic surgery for the initial treatment of oropharyngeal squamous cell carcinoma found that immediately after surgery, there was a significant reduction in quality-of-life and functional speech and swallowing measures, with the transoral robotic surgery–only group having the greatest recovery with the least weight loss and best swallowing-related outcomes at long-term follow-up.

Meaning  Patients who undergo adjuvant treatment after transoral robotic surgery may have poorer long-term outcomes, with continued dysphagia more than 1 year after surgery.


Importance  In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies.

Objective  To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT).

Design, Setting, and Participants  This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital.

Main Outcomes and Measures  Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients.

Results  Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, −16.1; 97.5% CI, −29.8 to −2.4) and the TORS-only and TORS+CRT groups (mean difference, −14.6; 97.5% CI, −29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale–Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life–Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3).

Conclusions and Relevance  Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.