van Loon J W L, Smeele L E, Hilgers F J M, van den Brekel M W M
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 2015 Jan;272(1):175-83. doi: 10.1007/s00405-014-2939-0. Epub 2014 Mar 8.
Traditionally T1-2N0 oropharyngeal carcinoma is treated with a single treatment modality, being either radiotherapy or surgery. Currently, minimally invasive surgery, such as transoral robotic surgery (TORS), is gaining popularity. The aim of this study is to assess whether T1-2N0 oropharyngeal cancer can be safely and effectively resected with TORS, and to determine the oncologic and functional outcomes. In addition, the long-term quality-of-life outcomes are reported. Between 2007 and 2012, 18 patients with early stage oropharyngeal cancers underwent transoral resection with the da Vinci robot system in the Netherlands Cancer Institute. All surviving patients filled out the self-report assessments of quality-of-life questionnaires. Median robot-assisted operating time was 115 min (range 43-186 min), while median estimated blood loss was 5 ml (range 0-125 ml). In three cases the exposure was insufficient to obtain clear tumor margins because of tumor extension and local anatomy. Fourteen patients had clear surgical margins. Four patients received adjuvant radiotherapy. Nine patients underwent an elective unilateral neck dissection. The oropharyngeal cancer recurred in two patients. Regarding the quality of life, patients who needed postoperative radiotherapy had a worse outcome and patients treated with transoral resection only did quite well. TORS seems to be an oncologically safe surgical treatment for early stage T1-2N0 oropharyngeal cancer based on this relatively small group of patients. Selecting patients in whom sufficient surgical exposure can be obtained, should be performed with the greatest care to avoid the need for adjuvant radiotherapy. Comparing radiotherapy and TORS or CO2 laser should be the next step in finding the optimal treatment for patients with T1-2N0 oropharyngeal carcinoma.
传统上，T1-2N0期口咽癌采用单一治疗方式，即放疗或手术。目前，诸如经口机器人手术（TORS）等微创手术正日益普及。本研究的目的是评估T1-2N0期口咽癌能否通过TORS安全有效地切除，并确定肿瘤学和功能学结果。此外，还报告了长期生活质量结果。2007年至2012年期间，荷兰癌症研究所的18例早期口咽癌患者接受了达芬奇机器人系统经口切除术。所有存活患者均填写了生活质量问卷的自我报告评估。机器人辅助手术的中位时间为115分钟（范围43-186分钟），而中位估计失血量为5毫升（范围0-125毫升）。3例因肿瘤侵犯和局部解剖结构导致暴露不足，无法获得清晰的肿瘤切缘。14例患者手术切缘清晰。有4例患者接受了辅助放疗。9例患者接受了选择性单侧颈清扫术。2例患者口咽癌复发。关于生活质量，需要术后放疗的患者结果较差，而仅接受经口切除术的患者情况良好。基于这一相对较小的患者群体，TORS似乎是早期T1-2N0期口咽癌在肿瘤学上安全的手术治疗方法。选择能够获得足够手术暴露的患者时应格外谨慎以避免辅助放疗的需要。比较放疗与TORS或二氧化碳激光治疗应是为T1-2N0期口咽癌患者寻找最佳治疗方法的下一步。
