Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology, Elsan Hospital, Poitiers, France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
Oral Oncol. 2024 Dec;159:107047. doi: 10.1016/j.oraloncology.2024.107047. Epub 2024 Sep 29.
This systematic review investigated the surgical, functional, and oncological outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL) for cT1-T3 laryngeal squamous cell carcinoma (LSCC).
Two investigators conducted an updated PubMed, Scopus, and Cochrane Library systematic review for studies investigating the surgical, functional, and oncological outcomes of TORS-SGL using the PRISMA statements. The bias analysis was conducted with the MINORS.
Twenty-one studies were included, accounting for 896 patients. TORS-SGL was primarily performed for cT1 (39.1 %), cT2 (46.9 %), and some selected cT3 (7.7 %) LSCCs. Surgical margins were positive in 10.8 % of cases. The mean hospital stay was 8.6 days. Hemorrhage (6.3 %), pneumonia (5.5 %), and aspiration (1.7 %) are the primary complications. The surgical margins were positive in 10.6 % of cases. Feeding tubes, temporary tracheotomy, and definitive percutaneous gastrostomy are found in 65.6 %, 19.7 %, and 5.2 % of patients, respectively. The oral diet is restarted after a mean of 7.2 days. The 5-year OS and DFS of TORS-SGL were estimated to be 78.3 %, and 91.7 %, with 5-year local-relapse-free survival and nodal-relapse-free survival of 90.8 %, and 86.6 %, respectively.
The TORS-SGL is a safe, and effective surgical approach for cT1-T3 SGL. The functional and surgical outcomes appear comparable with TOLM-SGL. The oncological outcomes of TORS-SGL could be better than TOLM and open SGLs, but further large cohort-controlled studies are needed to draw reliable conclusions.
本系统评价研究了经口机器人辅助声门上喉切除术（TORS-SGL）治疗 cT1-T3 喉鳞状细胞癌（LSCC）的手术、功能和肿瘤学结果。
两位研究者按照 PRISMA 声明，对使用 TORS-SGL 进行手术、功能和肿瘤学结果研究的更新版 PubMed、Scopus 和 Cochrane Library 系统评价进行了研究。使用 MINORS 进行偏倚分析。
纳入了 21 项研究，共 896 例患者。TORS-SGL 主要用于 cT1（39.1%）、cT2（46.9%）和一些选择的 cT3（7.7%）LSCC。10.8%的病例切缘阳性。平均住院时间为 8.6 天。主要并发症为出血（6.3%）、肺炎（5.5%）和吸入（1.7%）。10.6%的病例切缘阳性。65.6%、19.7%和 5.2%的患者分别使用了喂养管、临时气管切开和经皮胃造口术。平均 7.2 天后恢复口服饮食。TORS-SGL 的 5 年 OS 和 DFS 估计分别为 78.3%和 91.7%，5 年局部无复发生存率和无淋巴结转移生存率分别为 90.8%和 86.6%。
TORS-SGL 是一种安全有效的 cT1-T3 SGL 手术方法。功能和手术结果似乎与 TOLM-SGL 相当。TORS-SGL 的肿瘤学结果可能优于 TOLM 和开放式 SGL，但需要进一步的大样本对照研究来得出可靠的结论。
