Kayhan Fatma Tulin, Koc Arzu Karaman, Erdim Ibrahim
Mega-med Health Services, Istanbul, Turkey.
Bakirkoy Training and Research Hospital, Istanbul, Turkey.
Auris Nasus Larynx. 2019 Apr;46(2):285-293. doi: 10.1016/j.anl.2018.08.015. Epub 2018 Sep 11.
Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.
We retrospectively investigated patients with early glottic carcinoma (Tis, T1, T2) who underwent TORS cordectomy in a tertiary hospital between January 2010 and June 2018.
Forty-eight patients were enrolled in the study. Mean follow-up time was 65.6±16.6months. Only one patient died and overall survival rate was found 97.9%. Local recurrence occurred in five patients and disease free survival rate was found 89.6%. Anterior commissure involvement was occurred in 6 (12.5%) patients and local recurrence was seen two of them (33.3%). Synechia complication was occurred in 8 (16.7%) patients and local recurrence was seen three of them (36.7%). Although local recurrence rate was high in both anterior commissure involvement and synechia, only synechia reached to statistical significance for local recurrence (p: 0.027). The recurrences of four patients were treated with radiation therapy (RT) and the remaining one patient underwent total laryngectomy. Laryngeal preservation rate was found 97.9%.
Our investigation of the oncological outcomes of TORS on early-stage glottic carcinoma revealed that TORS has similar results when compared with transoral laser microsurgery and RT in terms of recurrence, laryngeal preservation and survival rates. Synechia is also a cautionary complication for recurrence and must be followed closely. We expect that TORS usage will be wider if robotic technology works on innovative developments oriented to glottic area.
尽管声门水平是达芬奇系统的非标签用途，但经口机器人手术（TORS）治疗早期（Tis、T1、T2）声门癌的可行性和早期结果已有文献记载。但关于肿瘤学结果知之甚少。我们调查了至少随访三年且平均随访时间超过五年的TORS患者的肿瘤学结果。
我们回顾性调查了2010年1月至2018年6月在一家三级医院接受TORS声带切除术的早期声门癌（Tis、T1、T2）患者。
48例患者纳入本研究。平均随访时间为65.6±16.6个月。仅1例患者死亡，总生存率为97.9%。5例患者出现局部复发，无病生存率为89.6%。6例（12.5%）患者出现前联合受累，其中2例（33.3%）出现局部复发。8例（16.7%）患者出现粘连并发症，其中3例（36.7%）出现局部复发。尽管前联合受累和粘连的局部复发率均较高，但只有粘连的局部复发具有统计学意义（p：0.027）。4例复发患者接受了放射治疗（RT），其余1例患者接受了全喉切除术。喉保留率为97.9%。
我们对TORS治疗早期声门癌的肿瘤学结果的调查显示，TORS在复发、喉保留和生存率方面与经口激光显微手术和RT相比有相似的结果。粘连也是复发的警示性并发症，必须密切随访。我们预计，如果机器人技术朝着声门区域的创新发展方向发展，TORS的应用将会更广泛。
