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Functional and oncological outcomes of salvage transoral robotic surgery: a comparative study

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Abstract

Purpose

Transoral robotic surgery (TORS) as a first-line therapy has been well-documented but evidence is missing regarding salvage therapy. The aim of this study is to compare the oncological and functional outcomes of TORS as a primary and salvage therapy.

Methods

This retrospective monocentric study included 74 patients operated by a single surgeon and sorted out into two groups: primary treatment (PT) or Salvage treatment (ST) in case of previous history of radiation therapy. Patients were further stratified by tumour location: larynx and pharynx (lST vs lPT and pST vs pPT).

Results

Forty-eight patients were included in PT group (64.9%) and 26 in ST group (35.1%). ST patients had more frequent cTis/T1 tumours (57.7% vs 29.2%, p = 0.0164) and no clinical lymph disease (3.8% vs 37.5%, p = 0.0016). Tracheostomy was more often performed in the ST group (57.7% vs 16.7%, p = 0.0003) and the lST subgroup (88.9% vs 9.1%, p < 0.0001). Gastric feeding tube placement was more frequent in the ST group (76.9% vs 33.3%, p = 0.0003), the pST subgroup (64.7% vs 15.4%, p = 0.0009) and the lST subgroup (100% vs 54.5%, p = 0.0297). We observed a trend for more postoperative complications in the ST group (69.2% vs 47.9%, p = 0.0783). The overall survival was lower in the ST group (p = 0.0004), and in the pST subgroup (p < 0.0001). The disease-free survival rate was lower in the ST group (p = 0.0001), the pST subgroup (p = 0.0002) and the lST subgroup (p = 0.0328).

Conclusion

This study confirms that survival and functional outcomes after salvage TORS are worse than in first line surgery.

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Authors and Affiliations

  1. Department of ENT Head and Neck Surgery, Institut Claudius Regaud, IUCT-Oncopole, 1 Av. Irène Joliot-Curie, 31059, Toulouse, France

    Pierre Gazda, Clément Gauche, Emilien Chabrillac, Benjamin Vairel, Agnès Dupret-Bories & Sébastien Vergez

  2. Department of ENT Head and Neck Surgery, CHU Larrey, 24 chemin de Pourvourville, 31400, Toulouse, France

    Pierre Gazda, Clément Gauche, Emilien Chabrillac, Benjamin Vairel, Guillaume De Bonnecaze & Sébastien Vergez

  3. Department of Biostatistics, Institut Claudius Regaud, IUCT Oncopole, 1 Av. Irène Joliot-Curie, 31059, Toulouse, France

    Léonor Chaltiel & Thomas Filleron

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  1. Pierre Gazda
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Gazda, P., Gauche, C., Chaltiel, L. et al. Functional and oncological outcomes of salvage transoral robotic surgery: a comparative study. Eur Arch Otorhinolaryngol 279, 457–466 (2022). https://doi.org/10.1007/s00405-021-06812-7

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