Oncologic outcomes after transoral robotic surgery a multi-institutional study

John R. De Almeida, Ryan Li, J. Scott Magnuson, Richard V. Smith, Eric Moore, Georges Lawson, Marc Remacle, Ian Ganly, Dennis H. Kraus, Marita S. Teng, Brett A. Miles, Hilliary White, Umamaheswar Duvvuri, Robert L. Ferris, Vikas Mehta, Krista Kiyosaki, Edward J. Damrose, Steven J. Wang, Michael E. Kupferman, Yoon Woo KohEric M. Genden, F. Christopher Holsinger

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

IMPORTANCE Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. OBJECTIVES To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. INTERVENTIONS Select patients received radiation therapy and/or chemotherapy before or after TORS. MAIN OUTCOMES AND MEASURES Locoregional control, disease-specific survival, and overall survival were calculated.We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors. RESULTS Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8%(95%CI, 87.6%-94.7%), disease-specific survival 94.5%(95%CI, 90.6%-96.8%), and overall survival 91%(95%CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P =.05) and for patients with tumors arising in tonsil (P =.01). Smoking was associated with worse overall all-cause mortality (P =.01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis. CONCLUSIONS AND RELEVANCE This large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.

Original languageEnglish (US)
Pages (from-to)1043-1051
Number of pages9
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume141
Issue number12
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Robotics
Survival
Head and Neck Neoplasms
Oropharyngeal Neoplasms
Radiotherapy
Multivariate Analysis
Recurrence
Pharyngeal Neoplasms
Drug Therapy
Neck Dissection
Laryngeal Neoplasms
National Cancer Institute (U.S.)
Mortality
Palatine Tonsil
Kaplan-Meier Estimate
Tobacco Use
Survival Analysis
Neoplasms
Therapeutics
Smoking

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

De Almeida, J. R., Li, R., Magnuson, J. S., Smith, R. V., Moore, E., Lawson, G., ... Holsinger, F. C. (2015). Oncologic outcomes after transoral robotic surgery a multi-institutional study. JAMA Otolaryngology - Head and Neck Surgery, 141(12), 1043-1051. https://doi.org/10.1001/jamaoto.2015.1508

Oncologic outcomes after transoral robotic surgery a multi-institutional study. / De Almeida, John R.; Li, Ryan; Magnuson, J. Scott; Smith, Richard V.; Moore, Eric; Lawson, Georges; Remacle, Marc; Ganly, Ian; Kraus, Dennis H.; Teng, Marita S.; Miles, Brett A.; White, Hilliary; Duvvuri, Umamaheswar; Ferris, Robert L.; Mehta, Vikas; Kiyosaki, Krista; Damrose, Edward J.; Wang, Steven J.; Kupferman, Michael E.; Koh, Yoon Woo; Genden, Eric M.; Holsinger, F. Christopher.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 141, No. 12, 01.12.2015, p. 1043-1051.

Research output: Contribution to journalArticle

De Almeida, JR, Li, R, Magnuson, JS, Smith, RV, Moore, E, Lawson, G, Remacle, M, Ganly, I, Kraus, DH, Teng, MS, Miles, BA, White, H, Duvvuri, U, Ferris, RL, Mehta, V, Kiyosaki, K, Damrose, EJ, Wang, SJ, Kupferman, ME, Koh, YW, Genden, EM & Holsinger, FC 2015, 'Oncologic outcomes after transoral robotic surgery a multi-institutional study', JAMA Otolaryngology - Head and Neck Surgery, vol. 141, no. 12, pp. 1043-1051. https://doi.org/10.1001/jamaoto.2015.1508
De Almeida, John R. ; Li, Ryan ; Magnuson, J. Scott ; Smith, Richard V. ; Moore, Eric ; Lawson, Georges ; Remacle, Marc ; Ganly, Ian ; Kraus, Dennis H. ; Teng, Marita S. ; Miles, Brett A. ; White, Hilliary ; Duvvuri, Umamaheswar ; Ferris, Robert L. ; Mehta, Vikas ; Kiyosaki, Krista ; Damrose, Edward J. ; Wang, Steven J. ; Kupferman, Michael E. ; Koh, Yoon Woo ; Genden, Eric M. ; Holsinger, F. Christopher. / Oncologic outcomes after transoral robotic surgery a multi-institutional study. In: JAMA Otolaryngology - Head and Neck Surgery. 2015 ; Vol. 141, No. 12. pp. 1043-1051.
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abstract = "IMPORTANCE Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. OBJECTIVES To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. INTERVENTIONS Select patients received radiation therapy and/or chemotherapy before or after TORS. MAIN OUTCOMES AND MEASURES Locoregional control, disease-specific survival, and overall survival were calculated.We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors. RESULTS Of the 410 patients treated with TORS in this study, 364 (88.8{\%}) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3{\%}) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8{\%}). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4{\%}), 15 (3.7{\%}), and 10 (2.4{\%}) of 410 patients, respectively. Seventeen (4.1{\%}) died of disease, and 13 (3.2{\%}) died of other causes. The 2-year locoregional control rate was 91.8{\%}(95{\%}CI, 87.6{\%}-94.7{\%}), disease-specific survival 94.5{\%}(95{\%}CI, 90.6{\%}-96.8{\%}), and overall survival 91{\%}(95{\%}CI, 86.5{\%}-94.0{\%}). Multivariate analysis identified improved survival among women (P =.05) and for patients with tumors arising in tonsil (P =.01). Smoking was associated with worse overall all-cause mortality (P =.01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis. CONCLUSIONS AND RELEVANCE This large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.",
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T1 - Oncologic outcomes after transoral robotic surgery a multi-institutional study

AU - De Almeida, John R.

AU - Li, Ryan

AU - Magnuson, J. Scott

AU - Smith, Richard V.

AU - Moore, Eric

AU - Lawson, Georges

AU - Remacle, Marc

AU - Ganly, Ian

AU - Kraus, Dennis H.

AU - Teng, Marita S.

AU - Miles, Brett A.

AU - White, Hilliary

AU - Duvvuri, Umamaheswar

AU - Ferris, Robert L.

AU - Mehta, Vikas

AU - Kiyosaki, Krista

AU - Damrose, Edward J.

AU - Wang, Steven J.

AU - Kupferman, Michael E.

AU - Koh, Yoon Woo

AU - Genden, Eric M.

AU - Holsinger, F. Christopher

PY - 2015/12/1

Y1 - 2015/12/1

N2 - IMPORTANCE Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. OBJECTIVES To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. INTERVENTIONS Select patients received radiation therapy and/or chemotherapy before or after TORS. MAIN OUTCOMES AND MEASURES Locoregional control, disease-specific survival, and overall survival were calculated.We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors. RESULTS Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8%(95%CI, 87.6%-94.7%), disease-specific survival 94.5%(95%CI, 90.6%-96.8%), and overall survival 91%(95%CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P =.05) and for patients with tumors arising in tonsil (P =.01). Smoking was associated with worse overall all-cause mortality (P =.01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis. CONCLUSIONS AND RELEVANCE This large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.

AB - IMPORTANCE Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. OBJECTIVES To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. INTERVENTIONS Select patients received radiation therapy and/or chemotherapy before or after TORS. MAIN OUTCOMES AND MEASURES Locoregional control, disease-specific survival, and overall survival were calculated.We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors. RESULTS Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8%(95%CI, 87.6%-94.7%), disease-specific survival 94.5%(95%CI, 90.6%-96.8%), and overall survival 91%(95%CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P =.05) and for patients with tumors arising in tonsil (P =.01). Smoking was associated with worse overall all-cause mortality (P =.01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis. CONCLUSIONS AND RELEVANCE This large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.

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