Study: Robotic surgery may be superior for HPV-related oral cancer

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Robotic surgery conducted through patients’ mouths provides excellent results in removing squamous cell carcinoma at the back of the throat, with outcomes similar or superior to other surgical and nonsurgical treatments, especially in nonsmoking patients with human papillomavirus (HPV), according to a study published in the March issue of Mayo Clinic Proceedings.

“Oropharyngeal squamous cell carcinoma (OP-SCCA) is an evolving cancer that affects a young and healthy population without traditional risk factors as well as patients with the traditional risk factors of tobacco and alcohol use,” wrote Eric J. Moore, MD, of the Mayo Clinic in Rochester, Minn., and colleagues. Surgical approaches to treatment had previously involved cutting and reconstructing the jawbone, neck and tongue, but developments over the last two decades have allowed resection of OP-SCCA through the mouth.

To determine the functional and oncologic results of transoral robotic surgery (TORS) as a primary therapy, the authors reviewed a prospective TORS database of patients with OP-SCCA who were treated between March 2007 and February 2009. Patients were selected to undergo TORS if the tumor was estimated to be completely resectable with TORS on the basis of preoperative imaging. A total of 66 patients were followed for a minimum of two years.

Results showed that 97 percent of patients were able to eat orally within three weeks of surgery and before starting adjuvant therapy. Long term use of a gastronomy tube or tracheotomy was required in three patients and one patient, respectively. Three-year estimated local control of the disease was 97 percent; regional control was 94 percent. After two years, researchers found that patients’ survival rate was greater than 92 percent, comparable to rates for some other surgical and nonsurgical treatments for oropharyngeal cancer.

“We were surprised that the cancer cure results were even better than the traditional treatments that we have been doing, but that is probably almost as much of a matter that these cancers are HPV-mediated for the most part, and they respond much better to treatment,” said Moore in a statement. “Importantly, the treatment preserved patients’ ability to swallow and their speech performance was excellent.”

The authors noted that in the past several decades, survival in OP-SCCA treatment has risen, and while the advances in treatments may have played a role, they suspected that the real reason may lie in the changing pathophysiology of the disease.

“The causative factor in many cases encountered today is HPV, and studies have shown that HPV-mediated OP-SCCA portends a favorable prognosis,” wrote the authors.

Lacking an alternative treatment group for comparative analysis, the study was limited, but it did provide preliminary data showing the robotic surgery is a viable treatment option, according to Moore. Continuing research involving multiple medical centers will investigate TORS in a larger population of patients with oropharyngeal cancer.