Fang Tuan-Jen, Lee Li-Ang, Huang Bing-Shan, Lin Chien-Yu, Hsu Cheng-Lung, Chang Joseph Tung-Chieh, Yen Tzu-Chen, Liao Chun-Ta, Chiang Hui-Chen
Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Eur Arch Otorhinolaryngol. 2017 Aug;274(8):3161-3168. doi: 10.1007/s00405-017-4594-8. Epub 2017 May 9.
The outcomes of second primary oropharyngeal cancer (SPOPC) may not be determined by oropharyngeal cancer but from the other index cancer as well. The management of (SPOPC) remains inconclusive and limited. Transoral robotic surgery (TORS) to maximize the functional outcomes without reducing oncologic effect is suggested as the primary treatment for selected oropharyngeal cancer. This study aimed to evaluate the feasibility and outcomes of TORS for the management of SPOPC. Patients who underwent TORS from January 2011 to June 2015 at a tertian referral center in Taiwan were recruited. Loco-regional status, overall survival (OS), disease-specific survival (DSS), and postoperative functional status were evaluated. Fifteen patients received TORS for SPOPC with curative intent, including eleven with tongue-base carcinomas, and four with tonsil carcinomas. One case was terminated because of inadequate exposure and the other 14 cases were completed with negative pathologic margins. Two-year OS and DSS were 53 and 77%, respectively. Patients with SPOPC occurring within 6 months had poorer outcomes (p = 0.044). The median time to feeding-tube removal was 5 days, and one patient had long-term gastric-tube dependence. Patients of age <65 years with synchronous SPOPC and esophageal cancer as the other index cancer were significant worse in oncologic outcomes. We concluded that TORS is a feasible alternative treatment in selected patients with SPOPC. Patients with metachronous T1-2 SPOPC without an esophageal primary can achieve excellent survival after TORS, while TORS can maximize functional preservation with limited destruction in patients with low life expectancy.
第二原发性口咽癌（SPOPC）的预后可能并非由口咽癌决定，还可能受其他原发癌影响。SPOPC的治疗方案尚无定论且有限。经口机器人手术（TORS）在不降低肿瘤治疗效果的前提下可最大化功能预后，被建议作为特定口咽癌的主要治疗方法。本研究旨在评估TORS治疗SPOPC的可行性和预后。招募了2011年1月至2015年6月在台湾一家三级转诊中心接受TORS治疗的患者。评估局部区域状态、总生存期（OS）、疾病特异性生存期（DSS）和术后功能状态。15例患者接受TORS治疗SPOPC，目的是根治，其中11例为舌根癌，4例为扁桃体癌。1例因暴露不充分终止手术，其他14例手术完成，病理切缘阴性。两年OS和DSS分别为53%和77%。6个月内发生SPOPC的患者预后较差（p = 0.044）。拔除饲管的中位时间为5天，1例患者长期依赖胃管。年龄＜65岁且同时患有SPOPC和食管癌作为其他原发癌的患者，肿瘤学预后明显更差。我们得出结论，TORS是特定SPOPC患者可行的替代治疗方法。异时性T1-2期且无食管原发癌的SPOPC患者在接受TORS治疗后可获得良好生存，而TORS可在预期寿命较低的患者中最大程度地保留功能，同时破坏有限。
