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Oral Cavity Tumours Including Lip Reconstruction
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The ultimate aim of surgical resection is removal of the tumour with adequate margins. For the majority of oral tumours this may be achieved via a per oral route33 with good retraction and lighting. Patients with trismus, microstomia, large or posteriorly based oral tumours may require additional access procedures to ensure adequate clearance of the tumour. The role of transoral robotic surgery continues to expand and undoubtedly its application to posterior oral tumours will develop in those institutions able to invest in this technology.
Case 13
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
Early laryngeal malignancy is usually treated with single modality therapy. The options are as follows: Radiotherapy. Transoral laser microsurgery.Transoral robotic surgery is performed in some centres.At present there is insufficient evidence to suggest any one modality is superior in terms of local control or survival rates. Surgical resection without the use of the laser has declined over the past decade.Transoral laser microsurgery is now the mainstay of surgical treatment and the research suggests that it is associated with higher rates of long term laryngeal preservation when compared to radiotherapy. There is debate about which modality provides superior voice function. Proponents of radiotherapy state that voice function is better with this modality but equally some studies have shown comparable or superior outcomes with transoral laser and this remains a contentious issue. The side effects of radiotherapy can be significant and, in cases of recurrent disease, it increases the morbidity of salvage surgery.As with all head and neck malignancies, the case should be discussed at a multi-disciplinary team (MDT) meeting to ensure the appropriate treatment for each patient.
The Radiobiology and Radiotherapy of HPV-Associated Head and Neck Squamous Cell Carcinoma
Published in Loredana G. Marcu, Iuliana Toma-Dasu, Alexandru Dasu, Claes Mercke, Radiotherapy and Clinical Radiobiology of Head and Neck Cancer, 2018
Loredana G. Marcu, Iuliana Toma-Dasu, Alexandru Dasu, Claes Mercke
Surgery remains an obvious choice for resectable HPV+ HNSCC. Lately, transoral robotic surgery is recommended instead of open surgery, due to better patient management and increased overall survival (Ford et al. 2014; Hammoudi et al. 2015). Nevertheless, the advantage of surgery over other treatment methods has not been demonstrated in HPV+ patients (Ang & Sturgis 2012).
Exstirpation of symptomatic lingual thyroid with transoral robotic surgery (TORS): A promising novel treatment option
Published in Acta Oto-Laryngologica Case Reports, 2022
Jonas Bruneau, Charbél Talani, Johan S. Nilsson
The non-invasive treatment options for LT are LT4 substitution/suppression and radioactive iodine therapy. However, especially with LT4 treatment, only partial response, if any, can be expected, and side effects in the long term can be deleterious. In the case of radioactive iodine therapy even enlargement of thyroid tissue may arise after treatment, although total responses have been reported [8], and the treatment is associated with harmful effects on gonads and other organs [6], and thus not neither suitable in younger patients. On the other hand, surgical treatment in the historic context has been associated with pronounced morbidity due to the access-related problems with open surgery. Recently, transoral robotic surgery (TORS) have emerged as a promising alternative to open surgical treatment, with, to our knowledge, the first procedure described in 2011 [9]. A PubMed database (www.ncbi.nlm.nih.gov) search on the 29th of July 2022 using either ‘ectopic thyroid’ AND ‘transoral robotic’, ‘lingual thyroid’ AND ‘transoral robotic’, or ‘lingual goiter’ AND ‘transoral robotic’ as entries, retrieved only 14 publications comprising 18 cases [9–22]. Further literature research for this study, generated by these publications, provided 6 more cases [7,23], thus in total 24 published cases, reflecting the novelty of the TORS approach in LT as well as the rarity of the diagnosis itself. In this report, we describe the first LT patient in Scandinavia treated with TORS.
Long-term survival outcomes after primary transoral robotic surgery (TORS) with concurrent neck dissection for early-stage oropharyngeal squamous cell carcinoma
Published in Acta Oto-Laryngologica, 2021
Joakim Grant Frederiksen, Hani Ibrahim Channir, Mikkel Hjordt Holm Larsen, Anders Christensen, Jeppe Friborg, Birgitte Wittenborg Charabi, Niclas Rubek, Christian von Buchwald
The current standard treatment for OPSCC in Denmark follows the Danish Head and Neck Cancer Group (DAHANCA) guidelines and consists of primary radiotherapy (RT) with or without concomitant chemotherapy. Following chemoradiotherapy (CRT), patient-reported quality of life (QoL) has been demonstrated to decline in domains like xerostomia, dysphagia and chewing ability which unfavourably impact the patient’s life [4]. Since 2009, there has been an increasing focus on transoral robotic surgery (TORS) as a promising single modality treatment option for early-stage OPSCC. TORS is a minimally invasive procedure that may represent an alternative to CRT therapy and subsequent treatment-related morbidity [5,6]. To date, studies evaluating TORS with adjuvant therapy have mainly focused on feasibility and early functional and oncologic outcomes and have so far shown comparable results with intensity-modulated radiation therapy (IMRT) with or without concomitant chemotherapy [7]. More recently, swallowing and QoL-related outcomes have become the main endpoints of interest, as illustrated in the first published phase 2 randomised trial comparing RT and TORS (ORATOR trial) [8].
Days alive and out of hospital a validated patient-centred outcome to be used for patients undergoing transoral robotic surgery: protocol and perspectives
Published in Acta Oto-Laryngologica, 2021
Mikkel Hjordt Holm Larsen, Susanne Irene Scott, Henrik Kehlet, Christian von Buchwald
Worldwide more than 92,000 patients are diagnosed with oropharyngeal cancer annually [8]. Since 2000 the incidence has been rising, due to a rise in Human Papillomavirus (HPV) associated cancer [9]. Traditionally treatment has consisted of radiotherapy with or without chemotherapy, which is associated with less morbidity compared to open surgery with a mandibular split. However, In 2009 the use of Transoral Robotic surgery (TORS) was approved by the U.S. Food and drug administration for the treatment of early-stages oropharyngeal cancer [10]. TORS is less invasive than open surgery and studies are currently comparing radiotherapy vs TORS with regards to functional outcomes and quality of life. TORS enables the surgeon to perform a safe transoral en-bloc resection of the oropharyngeal lesion with improved visualization and maneuverability compared to normal line of sight surgery.