Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Oral Oncol. 2012 Jun;48(6):560-6. doi: 10.1016/j.oraloncology.2011.12.011. Epub 2012 Jan 20.
The recent trend in treatment of hypopharyngeal cancer is organ preservation in order to maintain swallowing and speech function as well as improve quality of life. Transoral robotic surgery (TORS) can remove hypopharyngeal lesions successfully without an external incision, preserving physiologic functions of affected organs. However, studies have yet to assess the oncologic and functional results of TORS for the treatment of hypopharyngeal cancer. This prospective study evaluated the oncologic and functional results of TORS for the treatment of hypopharyngeal cancer obtained at our institution over a period of 3 years and confirmed the validity of TORS as a surgical organ-preserving strategy. Between April 2008 and September 2011, 23 patients who were diagnosed with hypopharyngeal cancer underwent TORS for removal of a primary lesion. The da Vinci Robotic system (Intuitive Surgical Inc., Sunnyvale, California) was used to remove the lesion. The Kaplan-Meier method was used to analyze overall survival and disease-free survival. Videopharyngogram study (VEF) was performed and functional outcome swallowing scale (FOSS) was utilized to measure and evaluate swallowing function. Acoustic wave form analysis was conducted to evaluate voice status. Overall survival at 3 years was 89% and disease-free survival was 84%. On the VEF study, serious aspiration or delay of swallowing was not observed during the pharyngeal stage of the swallowing process. Overall, 96% of the patients showed favorable swallowing abilities with an FOSS score ranging from 0 to 2. The fundamental frequency variation (vF0) and jitter were increased upon acoustic waveform analysis (vF0=2.71 ± 0.063, Jitter=2.01 ± 0.034), but the harmonic-to-noise ratio (HNR) and shimmer were maintained close to the normal range (HNR=1.28 ± 0.001, Shim=1.74 ± 0.036). The oncologic and functional results of TORS were quite acceptable for the treatment of hypopharyngeal cancer. TORS is a valid treatment option as a surgical, organ-preserving strategy for select patients with hypopharyngeal cancer.
近年来，治疗下咽癌的趋势是器官保留，以维持吞咽和言语功能，并提高生活质量。经口机器人手术（TORS）可以成功切除下咽病变，无需外部切口，保留受影响器官的生理功能。然而，目前还没有研究评估 TORS 治疗下咽癌的肿瘤学和功能结果。本前瞻性研究评估了我机构在 3 年期间使用 TORS 治疗下咽癌的肿瘤学和功能结果，并证实 TORS 作为一种保留器官的手术策略是有效的。2008 年 4 月至 2011 年 9 月，23 例被诊断为下咽癌的患者接受 TORS 切除原发肿瘤。使用达芬奇机器人系统（Intuitive Surgical Inc.，加利福尼亚州森尼韦尔）切除病变。采用 Kaplan-Meier 法分析总生存率和无病生存率。进行视频喉镜检查（VEF）并使用功能吞咽量表（FOSS）测量和评估吞咽功能。进行声波形分析以评估嗓音状况。3 年总生存率为 89%，无病生存率为 84%。在 VEF 研究中，在吞咽过程的咽部阶段未观察到严重的误吸或吞咽延迟。总体而言，96%的患者 FOSS 评分为 0 至 2 分，表明吞咽功能良好。声波形分析显示基频变化（vF0）和微扰增加（vF0=2.71±0.063，Jitter=2.01±0.034），但谐噪比（HNR）和抖动保持在接近正常范围（HNR=1.28±0.001，Shim=1.74±0.036）。TORS 治疗下咽癌的肿瘤学和功能结果相当令人满意。对于选择的下咽癌患者，TORS 是一种有效的手术保留器官治疗选择。
