Robotic surgery may improve mouth and throat cancer outcomes – study

Robotic surgery may improve outcomes in mouth and throat cancer, new research suggests.

The method is also associated with better long-term survival, the study indicates.

Oropharyngeal cancer occurs in the back of the throat and includes the base of the tongue and tonsils.

In transoral robotic surgery a surgeon uses a computer-enhanced system to guide an endoscope – a flexible tube with a light and camera attached to it – to provide high-resolution, 3D images of the back of the mouth and throat.

This is an area that is difficult to reach with conventional tools.

Two robotically guided instruments, acting as a surgeon’s arms, work around corners to safely remove tumours from surrounding tissue.

The Cedars-Sinai observational study published in JAMA Oncology, used data from the US National Cancer Database, and included 9,745 surgical patients – 2,694 of whom underwent transoral robotic surgery between 2010 and 2015.

Researchers found that the five-year overall survival rate for patients with early-stage disease who underwent robotic surgery was 84.5%, compared with 80.3% for patients who had non-robotic surgery.

They adjusted for differences in health and other characteristics of the two patient groups.

Zachary Zumsteg, assistant professor of radiation oncology at Cedars-Sinai, and corresponding author, said: “At a minimum, robotic surgery for oropharyngeal cancer patients seems safe and effective compared to what’s been the standard of care for many years.”

This was referring to standard surgery, radiation therapy and chemotherapy.

The study indicated that the proportion of patients undergoing transoral robotic surgery for early-stage oropharyngeal cancer increased dramatically after the US Food and Drug Administration approved the surgery for that cancer in 2009.

As well as increased overall survival rates, the researchers found that robotic surgery was associated with lower rates of positive surgical margins (cancer cells left behind at the edge of the tissue) – 12.5%, compared with a rate of 20.3% for non-robotic surgery in patients with oropharyngeal cancer.

Furthermore, robotic surgery was associated with less use of postoperative chemoradiation, at 28.6%, compared with 35.7% for patients who had non-robotic surgery.

Lead author Anthony Nguyen, a resident in the department of radiation oncology at Cedars-Sinai, said he hopes the research will inform future randomised, controlled clinical trials.

“Meanwhile, it’s reassuring to our patients that their survival rate is the same if not better with robotic surgery and they have the potential for a better quality of life,” he said.