Transoral Robotic Surgery for Advanced Oropharyngeal Carcinoma
Transoral Robotic Surgery for Advanced Oropharyngeal Carcinoma
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DOI：
10.1001/archoto.2010.191
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发表时间：
2010-11-01
影响因子：
--
通讯作者：
Quon, Harry
中科院分区：
文献类型：
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作者：
Weinstein, Gregory S.;O'Malley, Bert W., Jr.;Quon, Harry
目的：为了确定接受初次经口机器人手术后进行辅助治疗的晚期口咽癌患者的肿瘤学和功能结局，至少随访18个月。设计：前瞻性单中心队列研究。设置：学术大学卫生系统和三级转诊中心。患者：47名新诊断和既往未经治疗的晚期口咽癌成人。干预：经口机器人手术分期颈淋巴结清扫术和辅助治疗indicated.Main结果测量：边缘状态，复发，疾病特异性和无病生存，胃造口术管依赖性，安全性和有效性endpoints.Results：在47例入组的III期和IV期晚期口咽癌患者中，平均随访时间为26.6个月。无术中或术后死亡。1例患者（2%）切除边缘呈阳性。在末次随访时，1例患者（2%）发现局部复发，2例（4%）发现区域复发，4例（9%）发现远处复发。1年时疾病特异性生存率为98%（46例患者中的45例），2年时为90%（30例患者中的27例）。根据病理风险分层，47例患者中有18例（38%）避免化疗，5例（11%）在治疗方案中未接受辅助放疗和同期化疗。在最低随访1年，只有1例患者需要一个gastrostomy tube.Conclusions：这种新型的经口机器人手术治疗方案提供疾病控制，生存和安全相称的标准治疗和一个意想不到的有益结果的胃造口术依赖率，显着低于那些报道的标准非手术治疗。
Objectives: To determine the oncologic and functional outcomes in patients undergoing primary transoral robotic surgery followed by adjuvant therapy as indicated with a minimum of 18-month follow-up for advanced oropharyngeal carcinoma.Design: Prospective single-center cohort study.Setting: Academic university health system and tertiary referral center.Patients: Forty-seven adults with newly diagnosed and previously untreated advanced oropharyngeal carcinoma.Intervention: Transoral robotic surgery with staged neck dissection and adjuvant therapy as indicated.Main Outcome Measures: Margin status, recurrence, disease-specific and disease-free survival, gastrostomy tube dependence, and safety and efficacy end points.Results: In the 47 patients enrolled with stages III and IV advanced oropharyngeal carcinoma, mean follow-up was 26.6 months. There was no intraoperative or postoperative mortality. Resection margins were positive in 1 patient (2%). At last follow-up, local recurrence was identified in 1 patient (2%), regional recurrence in 2 (4%), and distant recurrence in 4 (9%). Disease-specific survival was 98% (45 of 46 patients) at 1 year and 90% (27 of 30 patients) at 2 years. Based on pathologic risk stratification, 18 of 47 patients (38%) avoided chemotherapy, and 5 patients (11%) did not receive adjuvantradiotherapy and concurrent chemotherapy in their treatment regimen. At minimum follow-up of 1 year, only 1 patient required a gastrostomy tube.Conclusions: This novel transoral robotic surgery treatment regimen offers disease control, survival, and safety commensurate with standard treatments and an unexpected beneficial outcome of gastrostomy dependency rates that are markedly lower than those reported with standard nonsurgical therapies.