Guarino Pierre, Chiari Francesco, Cordeschi Sara, D'Alessio Pasquale, Ingelido Carla, Motta Giovanni, Presutti Livio, Molteni Gabriele, Caporale Claudio Donadio
Otolaryngology Head and Neck Unit, "Santo Spirito" Hospital, 65124 Pescara, Italy.
Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy.
J Clin Med. 2024 Oct 10;13(20):6039. doi: 10.3390/jcm13206039.
Transoral robotic surgery (TORS) is nowadays considered a valuable minimally invasive approach to treat oropharyngeal squamous cell carcinoma (OPSCC). The aim of this technique is to improve functional preservation and reduce morbidity with excellent oncologic outcomes compared to the traditional transoral approach and chemoradiotherapy (CRT). The purpose of this systematic review is to assess an exhaustive overview of functional outcomes of TORS for OPSCC by evaluating several parameters reported in the available literature, such as the prevalence and dependence of tracheotomy, feeding tubes (FTs) and percutaneous endoscopic gastrostomy (PEG), the length of hospitalization, swallowing scores, speech tests and quality of life (QoL) questionnaires. : A systematic literature review has been performed following the PRISMA 2020 checklist statement. A computer-aided search was carried out using an extensive set of queries on the Embase/PubMed, Scopus and Web of Sciences databases relating to papers published from 2007 to 2024. : A total of 28 papers were systematically reviewed, reporting 1541 patients' data. The mean time of hospitalization was 6 days. A planned tracheotomy was performed in 8% of patients with a mean time of removal of 8 days. The prevalence and dependence of FT was 60% and 10%, respectively. Moreover, the presence of a high-stage T tumor with the contextual requirement of adjuvant therapies, the involvement of base tongues and the patient's age being >55 years increased the risk of requiring an FT and PEG. Swallowing and long-term QoL outcomes highlight the superiority of the TORS approach alone compared to TORS with adjuvant therapies. : TORS presented various favorable functional outcomes compared to other surgical approaches and primary CRT. However, adjuvant therapies after TORS strongly reduced the advantage of the robotic procedure, thus suggesting that T1 and T2 tumors may benefit mainly from TORS alone.
经口机器人手术（TORS）如今被认为是治疗口咽鳞状细胞癌（OPSCC）的一种有价值的微创方法。与传统经口手术和放化疗（CRT）相比，该技术的目的是在实现良好肿瘤学结果的同时，改善功能保留并降低发病率。本系统评价的目的是通过评估现有文献中报道的几个参数，全面概述TORS治疗OPSCC的功能结果，这些参数包括气管切开术、饲管（FTs）和经皮内镜下胃造口术（PEG）的发生率及依赖情况、住院时间、吞咽评分、语音测试和生活质量（QoL）问卷。：按照PRISMA 2020清单声明进行了系统的文献综述。使用一系列广泛的检索词在Embase/PubMed、Scopus和Web of Sciences数据库中进行了计算机辅助检索，检索与2007年至2024年发表的论文相关的文献。：共系统评价了28篇论文，报告了1541例患者的数据。平均住院时间为6天。8%的患者进行了计划性气管切开术，平均拔除时间为8天。FT的发生率和依赖率分别为60%和10%。此外，存在高分期T肿瘤且有辅助治疗的背景需求、舌根受累以及患者年龄>55岁会增加需要FT和PEG的风险。吞咽和长期QoL结果突出了单纯TORS方法相对于联合辅助治疗的TORS方法的优越性。：与其他手术方法和原发性CRT相比，TORS呈现出各种有利的功能结果。然而，TORS后的辅助治疗大大降低了机器人手术的优势，因此表明T1和T2肿瘤可能主要单独受益于TORS。
