Machtay M., Perch S., Markiewicz D., Thaler E., Chalian A., Goldberg A., Kligerman M., Weinstein G. Combined Surgery and Postoperative Radiotherapy for Carcinoma of the Base of Radiotherapy for Carcinoma of the Base of Tongue: Analysis of Treatment Outcome and Prognostic Value of Margin Status. TransOral Robotic Surgery (TORS) - Penn Medicine Epub 2015 Oct 6. The .gov means its official. The doctor follows the path of the tracer to the first lymph node (sentinel node). In our included studies, patients with BOT OPSCC had a higher proportion of positive postoperative margins compared to patients with tonsillar OPSCC (28.1% vs. 7.5%). Mayo Clinic otolaryngologist Daniel L. Price, M.D. Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma. While a higher rate of positive margins was seen in BOT OPSCC when compared to tonsillar OPSCC, this did not translate to a higher recurrence rate in the BOT group. Inclusion in an NLM database does not imply endorsement of, or agreement with, Types of Throat (Oropharyngeal) Cancer - ACC | Penn Medicine During this procedure, a blue dye or radioactive tracer is injected near the cancer site. The consistency of the risk of bias assessment was checked by the two authors (N.S.P. Spellman J., Sload R., Kim P., Martin P., Calzada G. Staging Neck Dissection and Transoral Robotic Surgery Treatment Algorithm in Palatine Tonsil Cancer. and transmitted securely. Patient Selection for Transoral Robotic Surgery (TORS) in Or - LWW PubMedGoogle Scholar. https://doi.org/10.1007/978-3-319-49578-1_8, Tax calculation will be finalised during checkout. 2006 Feb;116(2):165-8 and J.G.N. Epub 2020 Aug 4. Nichols et al. health information, we will treat all of that information as protected health Available online: Sally G., Higgins J.P.T., editors. Articles including the surgical management of OPSCC with TORS that compared margin status, complications, and recurrence between tonsil and BOT were included. Locoregional and metastatic recurrence was combined into the variable total recurrence. Oral Squamous Cell Carcinoma: Histologic Risk Assessment, but Not Margin Status, Is Strongly Predictive of Local Disease-Free and Overall Survival. It's very important in transoral robotic surgery to get the maximum exposure that you can of the tumor. As postoperative hemorrhage after TORS can cause mortality, decreasing the risk factors for this complication is crucial to improving surgical care [71]. TORS is a less invasive form of surgery with extremely precise resection. Specimen oriented intraoperative margin assessment in oral cavity and oropharyngeal squamous cell carcinoma. All authors have read and agreed to the published version of the manuscript. TORS makes this possible with: It depends on your diagnosis. A total of 28 studies were included, comprising 1769 patients with tonsillar OPSCC and 1139 patients with BOT OPSCC. What is the follow-up care after TORS? TORS BOT mucosectomy was performed in seven cases of squamous cell carcinoma of unknown primary. Ectopic thyroid is a rare condition most often found at the base of the tongue, lingual thyroid (LT). This form of care is offered alongside curative or other treatments you may be receiving. 2016 Royal Australasian College of Surgeons. Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption. and T.C.) A more recent but smaller study endorsed these findings of margin status not being a predictive factor in p16 positive tumors [18]. Parsons JT, Mendenhall WM, Stringer SP, et al. Dr. Moore specializes in complex tumor removal and reconstructive surgery of the Head Cholangiocarcinoma discoveries and treatment approaches. Transoral Robotic Surgery for Base of Tongue Cancer Surgeons often partner with pathologists, who analyze tissue during surgery to make sure all of the cancer has been removed. Computer console where the surgeon manages the instruments and cameras every move. Small mouth or related factors that make access difficult. and T.C.) The reference lists of relevant articles and citing articles were manually searched to confirm the search strategy and identify additional articles. Hirshoren N., Ruskin O., Fua T., Kleid S., Magarey M., Dixon B. Transoral robotic surgery: Implementation as a tool in head and neck surgery A single-centre Australian experience. Brandwein-Gensler M., Teixeira M.S., Lewis C.M., Lee B., Rolnitzky L., Hille J.J., Genden E., Urken M.L., Wang B.Y. PMC If the sentinel node doesn't contain cancer, it's unlikely that other lymph nodes contain cancer. Comparison of total recurrence between tonsillar OPSCC and base of tongue OPSCC. This content does not have an Arabic version. Comparison of Survival After Transoral Robotic Surgery vs Nonrobotic Some insurers require referrals, or may have additional requirements for certain medical care. The utility of TORS regarding improvement in margin status is inconsistent. The search strategies are detailed in Appendix A. . Intra- and peri-operative outcomes of eight patients with early stage (T1-T2 . This node is removed and tested for cancer. Mayo Clinic doctors are studying new treatment protocols for people with HPV-associated tongue cancers that reduce the amount of treatment given and lower the risk of treatment side effects, without sacrificing cure rates. Transoral robotic surgery (TORS) refers to minimally invasive operative techniques that leverage the maneuverability and optics of a robotic surgical system to facilitate en bloc primary tumor resection with substantially reduced cosmetic and functional morbidity, shorter recovery, and lower infection risk relative to open approaches. Transoral robotic surgery (TORS) serves as an innovative minimally invasive approach to resecting tumors of the upper aerodigestive tract, particularly those involving the oropharynx. This research received no external funding. Federal government websites often end in .gov or .mil. Egger M., Smith G.D., Schneider M., Minder C. Bias in Meta-Analysis Detected by a Simple, Graphical Test. other information we have about you. AJCC-8ed nodal staging does not predict outcomes in surgically managed HPV-associated oropharyngeal cancer. Treatment typically involves neck dissection, wide field radiotherapy and chemotherapy. Zenga J., Suko J., Kallogjeri D., Pipkorn P., Nussenbaum B., Jackson R.S. 2020 Feb;14(1):85-89. doi: 10.1007/s11701-019-00938-x. Mayo Clinic in Jacksonville, Florida, is ranked highly performing for cancer by U.S. News & World Report. JAMA Otolaryngol Head Neck Surg. Da Vinci; base of tongue; transoral robotic surgery; unknown primary. The UK experience. The following outcomes specific to tonsillar or BOT subsite were extracted: the number of positive margins, locoregional and metastatic recurrence, and postoperative hemorrhage. Vergez S., Lallemant B., Ceruse P., Moriniere S., Aubry K., De Mones E., Benlyazid A., Mallet Y. ; software, N.S.P., T.C. (A) Rate of positive margin in tonsillar OPSCC after TORS; (B) Rate of positive margin in base of tongue OPSCC after TORS. 2020 Jul 8;11(7):2054270420921066. doi: 10.1177/2054270420921066. At Mayo Clinic, ear, nose and throat specialists (otorhinolaryngologists) work with radiation oncologists, oncologists, pathologists, radiologists and oral and maxillofacial surgeons as a multidisciplinary team that provides whole-person care for people with tongue cancer. to find which articles met all the inclusion and exclusion criteria necessary to be included in the final analysis. In this systematic review comparing tonsillar and BOT OPSCC, a higher rate of positive margins was seen in BOT OPSCC. TORS is a minimally invasive surgical approach that can remove cancer and benign tumors. Sterne J.A., Egger M. Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axis. These rates are similar to postoperative hemorrhage in all cases after TORS, which is reported to be between 1.5% and 13.0% [68,69,70,71,72]. (https://pubs.rsna.org/doi/10.1148/rg.336135518). Please enable it to take advantage of the complete set of features! The procedure is performed under general anesthesia where you will be completely asleep. 2020 Sep;45(5):732-738. doi: 10.1111/coa.13565. Accessibility The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has consistently risen over the past 40 years, secondary to an increase in human papillomavirus (HPV)-positive tumors [1,2,3]. } She was treated with a two-stage . enable-background: new; National Library of Medicine and T.C.) Careers. In OPSCC, the positive margin rate for all subsites after TORS has been cited as between 16.9% and 21.2% [53,54,55]. Skip to content Care at Mayo Clinic Care at Mayo Clinic About Mayo Clinic Request Appointment In looking at all the subsites combined, a few studies have endorsed TORS with adjuvant therapy to be superior to TORS alone, particularly when considering locoregional control [16,38]. Mayo Clinic Comprehensive Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, which recognizes scientific excellence and a multidisciplinary approach to cancer prevention, diagnosis and treatment. Studies were excluded if they did not detail these three outcome variables based on either the tonsillar or BOT subsite. At Mayo Clinic, palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. JAMA Otolaryngol Head Neck Surg. Results: Powered by BROADCASTMED Recent anatomic studies have focused on understanding the landmarks specific to . Click here for an email preview. Learn about the latest treatment innovations for pancreatic adenocarcinoma and how these innovations have extended survival. Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach. Alicandri-Ciufelli M., Bonali M., Piccinini A., Marra L., Ghidini A., Cunsolo E.M., Maiorana A., Presutti L., Conte P.F. Average time before return to normal swallowing function was 2.7 days. Clin Otolaryngol. Ear, nose and throat surgery (also called an otolaryngologist). Before National Library of Medicine government site. NCI CPTC Antibody Characterization Program, Laryngoscope. PubMed High heterogeneity between the studies limited the ability to perform clinically relevant subgroup analyses to identify which particular tonsillar or BOT OPSCC patients would be at a higher risk of these poor outcomes. Difficulty breathing that requires a tracheostomy. Both forest plots are shown in Figure 3A,B. Treatment typically involves neck dissection, wide field radiotherapy and chemotherapy. BroadcastMed Privacy Policy. The https:// ensures that you are connecting to the Authors Ghali E Ghali 1 , Andrew T Meram 2 Affiliations 1 . The Nicotine Dependence Center at Mayo Clinic can help people who want to stop using tobacco. Mayo Clinic doctors have extensive experience caring for people with tongue cancer. Transoral Robotic Surgery and the Unknown Primary. "We knew it was in the lymph nodes, but we didn't know where it originated. Bu D.D., Ferrandino R., Ba E.M.R., Liu S., Miles B.A., Teng M.S., Yao M., Genden E.M., Chai R.L. Gallitto M., Sindhu K., Wasserman I., De B., Gupta V., Miles B.A., Genden E.M., Posner M., Misiukiewicz K., Bakst R.L.
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