Dabas Surender, Dewan Abhinav, Ranjan Reetesh, Dewan Ajay Kumar, Puri Anoop, Shah Swati H, Sinha Rupal
Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India.
Int J Clin Oncol. 2015 Aug;20(4):693-700. doi: 10.1007/s10147-014-0774-3. Epub 2014 Dec 17.
The aim of this observational prospective study was to determine the technical feasibility, safety and adequacy of surgical margins for transoral robotic surgery (TORS) in oropharyngeal cancers.
From March 2013 to May 2014, 60 patients with oropharyngeal lesions underwent TORS with or without neck dissection using the 'DaVinci' robot. Patients were observed and data recorded on surgical time, blood loss, complications and functional outcome of patients.
All 60 patients underwent TORS, with neck dissection performed in 45 of the patients. A positive margin was seen in two patients (3.3 %). Intent to treatment was radical in 42 patients and salvage in 18 patients. None of the patients required tracheostomy, and one patient (1.66 %) died postoperatively. Postoperative complications in the form of primary haemorrhage required active intervention in three patients. Average estimated blood loss was 26.5 ± 31.1 ml. Postoperatively, all patients had adequate swallowing and speech function with nasal twang reported in three patients on long-term follow up. Patients started tolerating oral feeds within a week of procedure (mean 3.96 days), with the nasogastric tube removed on the ninth postoperative day (mean 9.19 days). No long-term gastrostomy tube dependency was reported.
TORS is a safe, feasible, minimally invasive procedure in patients with oropharyngeal cancers. It has the least morbidity and offers benefits in terms of avoidance of tracheostomy tube, prolonged Ryle's tube and gastrostomy dependency.
这项前瞻性观察性研究的目的是确定经口机器人手术（TORS）治疗口咽癌的技术可行性、安全性及手术切缘的充分性。
2013年3月至2014年5月，60例口咽病变患者使用“达芬奇”机器人接受了TORS手术，部分患者同时行或不行颈部清扫术。观察患者情况并记录手术时间、失血量、并发症及患者功能转归。
60例患者均接受了TORS手术，其中45例行颈部清扫术。2例患者（3.3%）切缘阳性。42例患者为根治性治疗，18例为挽救性治疗。无一例患者需要气管切开，1例患者（1.66%）术后死亡。3例患者因原发性出血这一术后并发症需要积极干预。平均估计失血量为26.5±31.1毫升。术后，所有患者吞咽和言语功能良好，长期随访中有3例患者报告有鼻音。患者术后一周内开始耐受经口进食（平均3.96天），术后第9天拔除鼻胃管（平均9.19天）。未报告有长期依赖胃造瘘管的情况。
TORS对于口咽癌患者是一种安全、可行的微创手术。它发病率最低，在避免气管切开管、延长鼻胃管留置时间及胃造瘘依赖方面具有优势。
