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Original Investigation
November 2013

Transoral Robotic Surgery for Oropharyngeal Cancer: Long-term Quality of Life and Functional Outcomes

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
  • 2Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
  • 3Department of Otolaryngology–Head and Neck Surgery, Kansas University Medical Center, Kansas City
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1099-1108. doi:10.1001/jamaoto.2013.2747
Abstract

Importance  Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially.

Objective  To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC.

Design, Participants, and Setting  This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center.

Interventions  Primary surgical resection via TORS and neck dissection as indicated.

Main Outcomes and Measures  Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected.

Results  Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both).

Conclusions and Relevance  Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.

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