Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: A Prospective Study of Feasibility and Functional Outcomes
Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: A Prospective Study of Feasibility and Functional Outcomes
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DOI：
10.1002/lary.20647
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发表时间：
2009-11-01
期刊：
影响因子：
2.6
通讯作者：
Kasperbauer, Jan L.
中科院分区：
文献类型：
--
作者：
Moore, Eric J.;Olsen, Kerry D.;Kasperbauer, Jan L.
目的/假设：探讨经口机器人手术作为口咽鳞状细胞癌外科治疗方法的可行性。研究设计：前瞻性案例研究。方法：45例未经治疗的口咽鳞状细胞癌患者行经口机器人手术切除肿瘤，伴或不伴颈部清扫，伴或不伴辅助治疗。观察患者的手术时间、出血量、手术并发症、气管造口管程、肠内喂养、恢复口腔饮食、言语结局、吞咽结局、肿瘤复发等数据。结果：所有45例患者均行全经口机器人手术切除，同时进行单侧或双侧颈部清扫。边缘未见肿瘤。35例平均手术时间为71.3分钟。T1期15例，T2期18例，T3期3例，T4a期9例。舌底原发肿瘤26例，扁桃体窝肿瘤19例。14例患者术中放置气管造口管，所有患者均取出气管造口管（平均使用时间7.0天）。22例（48.9%）患者放置了鼻胃饲管，所有患者都拔掉了饲管（平均使用时间12.5天）。8例患者放置了经皮胃造口术（PEG）管，所有8例患者最终都取出了PEG管（平均使用时间为140.3天）。平均住院时间为3.8天。没有重大的并发症，也没有手术因无法切除肿瘤而流产。结论：经口机器人手术是一种安全有效的口咽肿瘤手术治疗方法。该技术的优点包括有足够的能力观察和用双手操作舌底病变。在大多数病例中，患者能够保留或迅速恢复口咽功能。
Objectives/Hypothesis: To investigate the feasibility of transoral robotic surgery as a method of surgical treatment of oropharyngeal squamous cell carcinoma.Study Design: Prospective case study.Methods: Forty-five patients with previously untreated oropharyngeal squamous cell carcinoma underwent transoral robotic surgical removal of the tumor with or without neck dissection and with or without adjuvant therapy. Patients were observed and data were recorded on surgical time, blood loss, surgical complications, tracheostomy tube course, enteral feeding, and resumption of oral diet, speech outcomes, swallowing outcomes, and tumor recurrence.Results: All 45 patients underwent complete transoral robotic surgical excision with simultaneous unilateral or bilateral neck dissection. Margins were negative for tumor. Mean operating time for tumor removal was 71.3 minutes for the last 35 cases. There were 15 stage T1 tumors, 18 T2 tumors, 3 T3 tumors, and 9 T4a tumors. Twenty-six patients had base of tongue primary tumors and 19 had tonsillar fossa tumors. Fourteen patients had a tracheostomy tube placed at surgery, and all patients had their tracheostomy tube removed (mean duration of use, 7.0 days). Twenty-two patients (48.9%) had a nasogastric feeding tube placed, and all patients had their feeding tube removed (mean duration of use, 12.5 days). Eight patients had percutaneous gastrostomy (PEG) tubes placed, and all eight eventually had their PEG tubes removed (mean duration of use, 140.3 days). Average hospital stay was 3.8 days. There were no major complications and no procedure was aborted because of an inability to remove the tumor.Conclusions: Transoral robotic surgery is a safe and efficacious method of surgical treatment of oropharyngeal neoplasms. Advantages of the technique include adequate ability to visualize and manipulate with two hands lesions in the base of tongue. Patients were able to retain or rapidly regain oropharyngeal function in the majority of cases.