Functional outcomes after transoral robotic surgery for head and neck cancer
Functional outcomes after transoral robotic surgery for head and neck cancer
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DOI：
10.1016/j.otohns.2009.05.014
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发表时间：
2009-08-01
影响因子：
3.4
通讯作者：
Magnuson, J. Scott
中科院分区：
文献类型：
--
作者：
Iseli, Tim A.;Kulbersh, Brian D.;Magnuson, J. Scott
目的：评估经口机器人头颈癌手术后的功能结局。研究设计：计划数据收集的病例系列。环境：学术医院。对象和方法：2007年3月至2008年12月期间，62名候选患者中的54名接受了经口机器人肿瘤切除术。结果：肿瘤最常见的是口咽（61%）或喉（22%）和T1（35%）或T2（44%），许多接受放疗（术前22%，术后41%）和化疗（31%）。气管内插管保留（22%）长达48小时，气管切开术较少（9%），所有患者均在14天内拔管。大多数患者在出院前（69%）或两周内（83%）开始口服。术后吞咽困难量表评分较差与保留饲管（P = 0.020）、年龄> 60（P = 0.017）、较高的T分期（P = 0.009）、喉部部位（P = 0.017）和并发症（P = 0.035）相关。在平均12个月的随访中，17%的患者保留了饲管（原发病例中为9.5%）。留置营养管与术前置管要求（P = 0.017）、较高T分期（P = 0.043）、口咽/喉部位（P = 0.034）和复发/第二原发肿瘤（P = 0.008）相关。并发症，包括气道水肿（9%），吸入（6%），出血（6%），和唾液瘘（2%）的管理没有重大的sequels.CONCLUSION：经口机器人手术提供了一个新兴的替代选定的原发性和挽救头颈部肿瘤的发病率低，可接受的功能结果。晚期T分期、喉或口咽部位和术前肠胃喂养的患者可能会增加肠胃喂养和吞咽不良结局的风险。(c)2009年美国耳鼻咽喉头颈外科学会基金会。All rights reserved.
OBJECTIVE: To evaluate functional outcomes following transoral robotic surgery for head and neck cancer.STUDY DESIGN: Case series with planned data collection.SETTING: Academic hospital.SUBJECTS AND METHODS: Between March 2007 and December 2008, 54 of 62 candidate patients underwent transoral robotic tumor resection. Outcomes include air-way management, swallowing (MD Anderson Dysphagia Inventory), and enterogastric feeding.RESULTS: Tumors were most commonly oropharynx (61%) or larynx (22%) and T1 (35%) or T2 (44%), Many received radiotherapy (22% preoperatively, 41% postoperatively) and chemotherapy (31%). Endotracheal intubation was retained (22%) for up to 48 hours, tracheostomy less frequently (9%), and all were decannulated by 14 days. Most commenced oral intake prior to discharge (69%) or within two weeks (83%). A worse postoperative Dysphagia Inventory score was associated with retained feeding tube (P = 0.020), age > 60 (P = 0.017), higher T stage (P = 0.009), laryngeal site (P = 0.017), and complications (P = 0.035). At a mean 12 months' follow-up, 17 percent retained a feeding tube (9.5% among primary cases). Retained feeding tube was associated with preoperative tube requirement (P = 0.017), higher T stage (P = 0.043), oropharyngeal/laryngeal site (P = 0.034), and recurrent/second primary tumor (P = 0.008). Complications including airway edema (9%), aspiration (6%), bleeding (6%), and salivary fistula (2%) were managed without major sequelae.CONCLUSION: Transoral robotic surgery provides an emerging alternative for selected primary and salvage head and neck tumors with low morbidity and acceptable functional outcomes. Patients with advanced T stage, laryngeal or oropharyngeal site, and preoperative enterogastric feeding may be at increased risk of enterogastric feeding and poor swallowing outcomes. (c) 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.