Effectiveness of transoral robotic surgery as salvage therapy for head and neck cancers
Date
2024
Authors
Goel, Sahil
Editors
Advisors
Lizarondo, Lucylynn
Foreman, Andrew (University of Adelaide and Royal Adelaide Hospital)
Foreman, Andrew (University of Adelaide and Royal Adelaide Hospital)
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Thesis
Citation
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Abstract
Background: Residual, recurrent and second primary head and neck cancers are increasingly prevalent, largely due to younger age at diagnosis and the growing use of targeted chemoradiotherapy options. Salvage surgery remains the only curative intent option in this cohort of patients. With transoral robotic surgery (TORS) achieving good oncological and functional outcomes in primary cancer cohorts, there remains a paucity of synthesised evidence on treating residual, recurrent or second primary disease in previously irradiated fields. Methods: Conducted in accordance with the JBI’s methodology for systematic reviews of effectiveness, three databases were searched including PubMed, Embase, and Scopus. Studies included underwent critical appraisal prior to data extraction. Meta-analysis of proportions and comparison was conducted using Freeman-Tukey arcsine transformation and Mantel-Haenszel statistical methods. Results: Data from 515 patients was analysed with a median follow up time up to 47 months and a mean hospital stay of 8.5 days. 2-year overall survival (OS) rate and disease-free survival (DFS) rate was 73.8% and 56.1% respectively. Compared to primary head and neck cancer (PHNC), risk ratios for OS and DFS were 0.35 (95% CI, 0.18-0.67) and 0.44 (95% CI, 0.22- 0.88). Weighted mean for tracheostomy decannulation and nasogastric dependence was 17.7 and 12.8 days respectively, with long term tracheostomy dependence in 0-11.5% of patients. Positive surgical margins were obtained in 19.4% with a risk ratio of 1.08 (95% CI, 0.66-1.75) when compared to PHNC. Recurrence rate was 36% (95% CI, 24-48.9). Pooled complication rate was 32.3% with 92% of complications being classed as Clavien Dindo grade 2 or 3. Conclusion: TORS is an emerging technique for salvage in recurrent, residual and second primary head and neck cancers in previously irradiated fields. Survival outcomes are encouraging with decreased morbidity and mortality rates when compared to traditional open surgical techniques. Future studies should prioritise the collection of swallowing data to better evaluate functional outcomes, deploy longer follow up times and address confounding factors including HPV status and prior adjuvant therapy.
School/Discipline
School of Public Health : JBI
Dissertation Note
Thesis (MClin.Sci.) -- University of Adelaide, School of Public Health : JBI, 2025
Provenance
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