Poupore Nicolas S, Chen Tiffany, Nguyen Shaun A, Nathan Cherie-Ann O, Newman Jason G
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA.
Cancers (Basel). 2022 Aug 8;14(15):3837. doi: 10.3390/cancers14153837.
Transoral Robotic Surgery (TORS) has become widely adopted for the surgical removal of oropharyngeal squamous cell carcinoma (OPSCC), with the most common locations being in the tonsil and base of tongue (BOT). However, it is currently unknown if TORS has equal efficacy and outcomes in patients with tonsillar or BOT OPSCC. Therefore, the aim of this study was to compare the margin status and recurrence rates of tonsillar and BOT OPSCC after TORS. Per PRISMA guidelines, PubMed, Scopus, and CINAHL were systematically searched from inception to 2/28/2022. Articles including the surgical management of OPSCC with TORS that compared margin status, complications, and recurrence between tonsil and BOT were included. Meta-analyses of proportions and odds ratios were performed. A total of 28 studies were included, comprising 1769 patients with tonsillar OPSCC and 1139 patients with BOT OPSCC. HPV positivity was seen in 92.3% of tumors. BOT OPSCC had a higher rate of positive margins compared to tonsillar OPSCC (28.1% [95%CI 15.1-43.3] vs. 7.5% [95%CI 3.3-13.3]). No differences were seen in recurrence between BOT and tonsillar OPSCC (OR 1.1 [95%CI 0.8-1.5], = 0.480). In addition, no differences in postoperative hemorrhage were seen between tonsillar and BOT OPSCC (10.7% [95%CI 6.1-16.5] vs. 8.8% [95% CI 1.5-21.3]). While a higher rate of positive margins was seen in BOT OPSCC when compared to tonsil OPSCC, this did not translate to a higher recurrence rate in the BOT group. Future research on which subset of patients with BOT is more likely to have positive margins is warranted to improve the utility of TORS further.
经口机器人手术（TORS）已被广泛应用于口咽鳞状细胞癌（OPSCC）的手术切除，最常见的部位是扁桃体和舌根（BOT）。然而，目前尚不清楚TORS在扁桃体或BOT OPSCC患者中是否具有相同的疗效和结果。因此，本研究的目的是比较TORS术后扁桃体和BOT OPSCC的切缘状态和复发率。按照PRISMA指南，从创刊到2022年2月28日对PubMed、Scopus和CINAHL进行了系统检索。纳入了包括用TORS进行OPSCC手术治疗且比较了扁桃体和BOT之间切缘状态、并发症和复发情况的文章。进行了比例和比值比的荟萃分析。共纳入28项研究，包括1769例扁桃体OPSCC患者和1139例BOT OPSCC患者。92.3%的肿瘤为HPV阳性。与扁桃体OPSCC相比，BOT OPSCC的切缘阳性率更高（28.1%[95%CI 15.1 - 43.3] vs. 7.5%[95%CI 3.3 - 13.3]）。BOT和扁桃体OPSCC之间的复发率没有差异（OR 1.1[95%CI 0.8 - 1.5]，P = 0.480）。此外，扁桃体和BOT OPSCC之间的术后出血情况也没有差异（10.7%[95%CI 6.1 - 16.5] vs. 8.8%[95%CI 1.5 - 21.3]）。虽然与扁桃体OPSCC相比，BOT OPSCC的切缘阳性率更高，但这并没有转化为BOT组更高的复发率。有必要对哪些BOT患者亚组更可能出现切缘阳性进行进一步研究，以进一步提高TORS的效用。
