Motz Kevin, Chang Hsien-Yen, Quon Harry, Richmon Jeremy, Eisele David W, Gourin Christine G
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 1;143(6):580-588. doi: 10.1001/jamaoto.2016.4634.
The treatment of oropharyngeal cancer has undergone a paradigm shift in the past 2 decades, with an increase in the use of nonoperative treatment owing to poor functional outcomes associated with traditional surgical approaches. Transoral robotic surgery (TORS) allows surgical resection of oropharyngeal cancer (OPC) with less morbidity through a minimally invasive approach.
To investigate the relationship among TORS and short- and long-term outcomes and costs in surgically treated patients with OPC.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional analysis of 3573 patients who underwent an ablative procedure for OPC in 2010 to 2012 using the MarketScan Commercial Claim and Encounters database.
The association between TORS and short- and long-term outcomes, length of hospitalization, and treatment-related costs was analyzed using descriptive statistics and multivariate regression modeling.
Transoral robotic surgery was performed in 304 surgical cases (8.5%); 94.7% of patients were 40 to 64 years old, and 70.7% were male. The use of TORS increased from 4.1% of surgical cases in 2010 to 13.2% of surgical cases in 2012. Patients who underwent TORS had a lower rate of tracheotomy during treatment (3.9% vs 11.4%), and posttreatment gastrostomy tube use (21.9% vs 34.2%), compared with patients undergoing non-TORS procedures. On multivariate analysis, TORS was not associated with significant differences in postoperative complications or length of hospitalization. There was no significant difference in the odds of receiving postoperative radiation therapy between patients who underwent TORS and those who did not; however, among patients receiving radiation therapy, chemoradiation was significantly less likely following TORS (odds ratio [OR], 0.52; 95% CI, 0.29-0.90). TORS was associated with significantly decreased odds of posttreatment gastrostomy (OR, 0.54; 95% CI. 0.30-0.95) and tracheostomy during treatment (OR, 0.17; 95% CI, 0.06-0.55) at 1 year, and was associated with significantly decreased overall treatment-related costs of care (mean incremental cost, -$22 724).
The use of TORS for surgical resection of OPC is increasing in the United States and is associated with significantly lower use of adjuvant chemoradiation, late gastrostomy and tracheostomy dependence, and lower overall treatment-related costs of care. These data have implications for discussions of value in OPC care at a time of health care reform.
在过去20年里，口咽癌的治疗发生了范式转变，由于传统手术方法导致的功能预后较差，非手术治疗的使用有所增加。经口机器人手术（TORS）通过微创方法能够以较低的发病率进行口咽癌（OPC）的手术切除。
探讨TORS与接受手术治疗的OPC患者的短期和长期预后以及成本之间的关系。
设计、设置和参与者：使用MarketScan商业索赔和病历数据库对2010年至2012年接受OPC消融手术的3573例患者进行回顾性横断面分析。
使用描述性统计和多变量回归模型分析TORS与短期和长期预后、住院时间以及治疗相关成本之间的关联。
304例手术病例（8.5%）采用了经口机器人手术；94.7%的患者年龄在40至64岁之间，70.7%为男性。TORS的使用从2010年手术病例的4.1%增加到2012年手术病例的13.2%。与未接受TORS手术的患者相比，接受TORS手术的患者在治疗期间气管切开率较低（3.9%对11.4%），治疗后胃造瘘管使用率也较低（21.9%对34.2%）。多变量分析显示，TORS与术后并发症或住院时间的显著差异无关。接受TORS手术的患者与未接受TORS手术的患者在接受术后放疗的几率上没有显著差异；然而，在接受放疗的患者中，TORS术后接受放化疗的可能性显著降低（优势比[OR]，0.52；95%置信区间，0.29 - 0.90）。TORS与治疗后1年胃造瘘（OR，0.54；95%置信区间，0.30 - 0.95）和治疗期间气管切开（OR，0.17；95%置信区间，0.06 - 0.55）的几率显著降低相关，并且与总体治疗相关护理成本显著降低相关（平均增量成本， - 22724美元）。
在美国，TORS用于OPC手术切除的使用正在增加，并且与辅助放化疗的使用显著降低、晚期胃造瘘和气管切开依赖以及总体治疗相关护理成本降低相关。这些数据对于在医疗改革时期讨论OPC护理的价值具有重要意义。
