Head and Neck Unit, The Royal Marsden Hospital, London, UK.
Department of Otolaryngology-H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
J Natl Cancer Inst. 2022 Oct 6;114(10):1400-1409. doi: 10.1093/jnci/djac130.
Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness.
A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC.
Data for 278 eligible patients were analyzed, with median follow-up of 38.5 months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0 mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0 mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0 mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n = 22 of 272), and 30-day mortality was 1.8% (n = 5 of 272). At 1 year, 10.8% (n = 21 of 195) used tracheostomies, 33.8% (n = 66 of 195) used gastrostomies, and 66.3% (n = 53 of 80) had maintained or improved normalcy of diet scores.
Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting.
经口机器人手术（TORS）是一种新兴的微创治疗方法，适用于先前接受过放疗的头颈部残留、复发和新原发性癌症，其肿瘤学疗效的证据有限。
对 2018 年 8 月前在 16 个国际高容量中心进行的连续病例进行回顾性观察队列研究（在 clinicaltrials.gov 上注册为 RECUT 研究 [NCT04673929]）。使用 Kaplan-Meier 估计计算总生存率（OS）、无病生存率、疾病特异性生存率（DSS）和局部控制率（LC），使用对数秩检验和 Cox 比例风险模型进行多变量分析比较亚组。最大选择秩统计确定基于 LC 的最接近手术切除边缘的切点。
对 278 名合格患者的数据进行了分析，中位随访时间为 38.5 个月。LC 的 2 年和 5 年结果分别为 69.0%和 62.2%，OS 为 71.8%和 49.8%，无病生存率为 47.2%和 35.7%，疾病特异性生存率为 78.7%和 59.1%。最具鉴别力的边缘切点为 1.0mm；2 年 LC 高于 80.9%，等于或低于 1.0mm 则为 54.2%。年龄增长、当前吸烟、原发肿瘤分类和狭窄手术切缘（≤1.0mm）与 OS 降低显著相关。272 例中有 8.1%（22 例）出现返回手术室的出血，30 天死亡率为 1.8%（272 例中有 5 例）。在 1 年时，195 例中有 10.8%（21 例）使用了气管造口术，195 例中有 33.8%（66 例）使用了胃造口术，80 例中有 66.3%（53 例）维持或改善了正常饮食评分。
来自国际中心的数据表明，经口机器人手术（TORS）用于治疗先前接受过放疗的头颈部癌症，可获得 LC 和生存的良好结果。在可行的情况下，TORS 应被视为挽救性治疗的首选手术治疗方法。
