Transoral Robotic Surgery for Recurrent Tumors of the Upper Aerodigestive Tract (RECUT): An International Cohort Study.

Autor:	Hardman JC; Head and Neck Unit, The Royal Marsden Hospital, London, UK., Holsinger FC; Department of Otolaryngology-H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA., Brady GC; Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK., Beharry A; Department of Otolaryngology-H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland., Bonifer AT; Department of Otolaryngology-H&N Surgery, Henry Ford Hospital, Detroit, MI, USA., D'Andréa G; Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France., Dabas SK; Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India., de Almeida JR; Department of Otolaryngology-H&N Surgery, University Health Network, Toronto, ON, Canada., Duvvuri U; Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA., Floros P; Department of Otolaryngology-H&N Surgery, Florida Hospital Group, Celebration, FL, USA., Ghanem TA; Department of Otolaryngology-H&N Surgery, Henry Ford Hospital, Detroit, MI, USA., Gorphe P; Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France., Gross ND; Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA., Hamilton D; Department of Otolaryngology-H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK., Kurukulasuriya C; Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA., Larsen MHH; Department of Head and Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark., Lin DJ; Department of Otolaryngology-H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK., Magnuson JS; Department of Otolaryngology-H&N Surgery, Florida Hospital Group, Celebration, FL, USA., Meulemans J; Otorhinolaryngology-Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium., Miles BA; Department of Otolaryngology Head and Neck Surgery, Northwell Health System, New York, NY, USA., Moore EJ; Department of Otolaryngology-H&N Surgery, Mayo Clinic, Rochester, MN, USA., Pantvaidya G; Department of H&N Surgery, Tata Memorial Hospital, Mumbai, India., Roof S; Department of Otolaryngology, Mount Sinai Hospital, New York City, NY, USA., Rubek N; Department of Head and Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark., Simon C; Department of Otolaryngology-H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland., Subash A; Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India., Topf MC; Department of Otolaryngology-H&N Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Van Abel KM; Department of Otolaryngology-H&N Surgery, Mayo Clinic, Rochester, MN, USA., Vander Poorten V; Otorhinolaryngology-Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium., Walgama ES; Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA., Greenlay E; Clinical Trials Unit, The Royal Marsden Hospital, London, UK., Potts L; Clinical Trials Unit, The Royal Marsden Hospital, London, UK., Balaji A; Department of H&N Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India., Starmer HM; Department of Otolaryngology-H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA., Stephen S; Department of Otolaryngology-H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK., Roe J; Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK., Harrington K; Head and Neck Unit, The Royal Marsden Hospital, London, UK., Paleri V; Head and Neck Unit, The Royal Marsden Hospital, London, UK.
Jazyk:	angličtina
Zdroj:	Journal of the National Cancer Institute [J Natl Cancer Inst] 2022 Oct 06; Vol. 114 (10), pp. 1400-1409.
DOI:	10.1093/jnci/djac130
Abstrakt:	Background: Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness. Methods: A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC. Results: Data for 278 eligible patients were analyzed, with median follow-up of 38.5 months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0 mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0 mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0 mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n = 22 of 272), and 30-day mortality was 1.8% (n = 5 of 272). At 1 year, 10.8% (n = 21 of 195) used tracheostomies, 33.8% (n = 66 of 195) used gastrostomies, and 66.3% (n = 53 of 80) had maintained or improved normalcy of diet scores. Conclusions: Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting. (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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