Transoral robotic surgery may improve long-term survival outcomes compared with nonrobotic surgery for patients with early-stage oropharyngeal cancer, according to research published in JAMA Oncology.
Patients with early-stage oropharyngeal squamous cell carcinoma (OPSCC) usually receive definitive radiotherapy over surgery due to higher morbidity that could accompany with surgical approaches. The development of minimally invasive approaches via transoral robotic surgery, however, has the potential to change this risk-benefit equation, according to researchers.
The research conducted a retrospective cohort comparative effectiveness analysis to compare long-term outcomes of transoral robotic surgery to nonrobotic surgery among 9,745 patients (mean age, 58.8 years; 78.5% men) with early-stage OPSCC. Among these patients 27.6% (n = 2,694) underwent robotic surgery.
Researchers conducted a multivariable Cox proportional hazards regression analysis and propensity score matching among patients with known HPV status (n = 4,071) to adjust for patient- and disease-related covariates.OS served as the primary endpoint. From 2010 to 2015, the use of robotic surgery for clinical T1 and T2 OPSCC increased from 18.3% (240 of 1,309) to 35.5% (654 of 1,831) of all surgical procedures (P = .003). Results showed associations between robotic surgery and lower rates of positive surgical margins (12.5% vs. 20.3%; P < .001) and adjuvant chemoradiotherapy use (28.6% vs. 35.7%; P < .001) compared with nonrobotic surgery.
Among the subset of patients with known HPV status, robotic surgery appeared associated with improved OS vs. nonrobotic surgery (HR = 0.74; 95% CI, 0.61-0.9). Those who received robotic vs. nonrobotic surgery had a higher 5-year OS rate (84.8% vs. 80.3%) in propensity score-matched cohorts (P = .002).
Researchers also compared survival after robotic and nonrobotic surgery among patients with prostate, endometrial and cervical cancers. Results showed no evidence that robotic surgery improved survival in prostate cancer (HR = 0.92; 95% CI, 0.79-1.07), endometrial cancer (HR = 0.97; 95% CI, 0.9-1.04) and cervical cancer (HR = 1.27; 95% CI, 0.96-1.69).
The results are hypothesis-generating and hopefully will inform future randomized, controlled clinical trials, according to Anthony T. Nguyen, MD, PhD, lead study author and resident in the department of radiation oncology at Cedars-Sinai.
However, it is reassuring that the survival rate is still the same if not better with robotic surgery and they have the potential for a better quality of life,” he said in the release.
“Ultimately, the reality for most solid tumours is that survival is rarely dictated solely by local control and the robot serves as a technical tool to improve operative intervention,” they added. “Thus, the key questions in cancer surgery always remain who should undergo resection and when not how. These techniques, and future improvements, will augment our capabilities as surgeons, but rigorous attention to the primary goals of safety and oncologic principles must remain the most important priorities.”