Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
Department of Surgery, Section of Otolaryngology, Yale-New Haven Hospital, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
Head Neck. 2019 Sep;41(9):3064-3072. doi: 10.1002/hed.25792. Epub 2019 May 6.
Purpose of the study is to assess nationwide margin performance in oropharynx transoral robotic surgery (TORS).
Retrospective review of the National Cancer Database.
Two thousand six hundred sixty-one patients were included. The national positive margin rate (PMR) was 16.9%. High-volume facilities had a lower PMR than low-volume facilities (12.7% vs 21.9%; P < .001). Patients with disease of the tonsil had a lower PMR (15.7%) than base-of-the-tongue (18.2%; P = .14). PMR increased with T classification (T1 = 13.0%, T2 = 17.1%, T3 = 28.2%, T4a = 45.9%, T4b = 58.3%; P < .001). On multivariable regression, factors associated with margin status included only lymph-vascular invasion (1.63[1.13-2.36]; P = .01), high volume (0.57[0.36-0.92]; P = .005), and T classification (as compared to T1, T2: 1.50[1.03-2.18], T3: 3.11[1.77-5.46], T4a: 7.03[2.95-16.75], T4b: 6.72[1.26-35.93]; P < .001).
National PMR is 16.9%, substantially higher than reported in high-volume TORS centers. There is a linear association between positive margins and T classification, with T3 and T4 PMRs exceeding 28%. High-volume facilities are half as likely to yield positive margins compared to low-volume facilities. There was no association between human papilloma virus status, tumor subsite, or academic facility status and positive margins.
本研究旨在评估口咽经口机器人手术（TORS）的全国切缘表现。
回顾性分析国家癌症数据库。
共纳入 2661 例患者。全国切缘阳性率（PMR）为 16.9%。高容量设施的 PMR 低于低容量设施（12.7%比 21.9%；P<.001）。扁桃体病变患者的 PMR（15.7%）低于舌根病变（18.2%；P=0.14）。PMR 随 T 分类增加而升高（T1 为 13.0%，T2 为 17.1%，T3 为 28.2%，T4a 为 45.9%，T4b 为 58.3%；P<.001）。多变量回归分析显示，与切缘状态相关的因素仅包括淋巴血管侵犯（1.63[1.13-2.36]；P=0.01）、高容量（0.57[0.36-0.92]；P=0.005）和 T 分类（与 T1 相比，T2：1.50[1.03-2.18]，T3：3.11[1.77-5.46]，T4a：7.03[2.95-16.75]，T4b：6.72[1.26-35.93]；P<.001）。
全国 PMR 为 16.9%，明显高于高容量 TORS 中心报告的 PMR。切缘阳性与 T 分类呈线性关系，T3 和 T4 的切缘阳性率超过 28%。与低容量设施相比，高容量设施产生阳性切缘的可能性减半。人乳头瘤病毒状态、肿瘤部位和学术机构地位与阳性切缘之间没有关联。
