Chen Michelle M, Roman Sanziana A, Kraus Dennis H, Sosa Julie A, Judson Benjamin L
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Otolaryngol Head Neck Surg. 2014 Jun;150(6):968-75. doi: 10.1177/0194599814525747. Epub 2014 Mar 11.
(1) To determine baseline demographic, geographic, clinical, and pathologic characteristics of patients who had transoral robotic surgery (TORS) for oropharyngeal cancer. (2) To analyze margin status and unplanned readmission after TORS versus nonrobotic surgery.
Retrospective database review.
National Cancer Database (2010-2011).
Searching the National Cancer Database for adults with oropharyngeal cancer, we identified 877 patients who had TORS and 4269 patients who had nonrobotic surgery. Outcomes of interest included likelihood of adjuvant therapy, margin status, and unplanned readmission. Statistical analysis included chi-square, t tests, and multivariate regression.
From 2010 to 2011, there was a 67% increase in the use of TORS for oropharyngeal cancer. Compared with patients who had nonrobotic surgery, TORS patients were more likely to be at academic centers (80.8% vs 49.1%, P < .001), to have private insurance (62.2% vs 57.4%, P < .001), and to have human papilloma virus (HPV)-positive tumors (48.3% vs 27.1%, P < .001). TORS (odds ratio, 0.50; 95% CI, 0.39-0.63) and HPV positivity (odds ratio, 0.73; 95% CI, 0.53-0.99) were independently associated with decreased likelihood of adjuvant chemoradiation versus radiation therapy. TORS patients were less likely to have positive margins than were patients who had nonrobotic surgery (20.2% vs 31.0%, P < .001). High-volume TORS centers had lower rates of positive margins (15.8% vs 26.1%, P < .001) and unplanned readmissions (3.1% vs 6.1%, P < .03) than did low-volume centers.
TORS is being rapidly adopted by academic and community cancer centers. TORS is associated with a lower rate of positive margins than nonrobotic surgery, and high-volume centers have the lowest rates of positive margins and unplanned readmissions.
（1）确定接受经口机器人手术（TORS）治疗口咽癌患者的基线人口统计学、地理、临床和病理特征。（2）分析TORS与非机器人手术相比的切缘状态和非计划再入院情况。
回顾性数据库分析。
国家癌症数据库（2010 - 2011年）。
在国家癌症数据库中搜索成年口咽癌患者，我们确定了877例行TORS的患者和4269例行非机器人手术的患者。感兴趣的结果包括辅助治疗的可能性、切缘状态和非计划再入院情况。统计分析包括卡方检验、t检验和多因素回归分析。
2010年至2011年，口咽癌TORS的使用增加了67%。与接受非机器人手术的患者相比，TORS患者更有可能在学术中心（80.8%对49.1%，P <.001），拥有私人保险（62.2%对57.4%，P <.001），以及患有人乳头瘤病毒（HPV）阳性肿瘤（48.3%对27.1%，P <.001）。TORS（比值比，0.50；95%可信区间，0.39 - 0.63）和HPV阳性（比值比，0.73；95%可信区间，0.53 - 0.99）与辅助放化疗相对于单纯放疗可能性降低独立相关。TORS患者切缘阳性的可能性低于接受非机器人手术的患者（20.2%对31.0%，P <.001）。高容量TORS中心切缘阳性率（15.8%对26.1%，P <.001）和非计划再入院率（3.1%对6.1%，P <.03）低于低容量中心。
学术和社区癌症中心正在迅速采用TORS。与非机器人手术相比，TORS切缘阳性率较低，高容量中心切缘阳性率和非计划再入院率最低。
