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A Cedars-Sinai surgical team conducts a robotic surgery

Robotics surgery may improve outcomes in mouth and throat cancer

Image credit: Cedars-Sinai

Robotic surgery may improve the health outcomes in mouth and throat cancer patients, including better long-term survival, new research suggests.

The method used for the study focused on oropharyngeal cancer that 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. 

Naturally, this is an area that is difficult to reach with conventional tools; therefore, robots can be used during this procedure. Here, two robotically guided instruments, acting as a surgeon’s arms, work around corners to safely remove tumours from surrounding tissue.

The observational study, conducted by non-profit Los Angeles hospital Cedars-Sinai, 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. 

“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,” said Zachary S Zumsteg, assistant professor of Radiation Oncology at Cedars-Sinai, referring to standard surgery, radiation therapy, and chemotherapy.

The researchers found that the five-year overall survival rate for patients with early-stage disease who underwent robotic surgery was 84.5 per cent, compared with 80.3 per cent for patients who had non-robotic surgery. They adjusted for differences in health and other characteristics of the two patient groups.

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 (FDA) approved the surgery for that cancer in 2009. 

The nationwide increase in transoral robotic surgery for oropharyngeal cancer prompted the investigators to assess whether the theoretical benefits of robotic surgery for oropharyngeal cancer patients actually provide outcomes that are superior or equivalent to the standard treatments for that cancer type and others.

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 per cent, compared with a rate of 20.3 per cent for non-robotic surgery in patients with oropharyngeal cancer.

Furthermore, the researchers said that robotic surgery was associated with less use of postoperative chemoradiation, at 28.6 per cent, compared with 35.7 per cent for patients who had non-robotic surgery.

“Our purpose in doing this study was to see how this new technology, which has never been tested in a randomised, controlled trial, has influenced patterns of treatment and outcomes since its FDA approval,” Zumsteg said. “There is a learning curve with any new surgical technique, and new ones don't always translate into equal or improved outcomes.”

Anthony Nguyen, a resident in the department of radiation oncology at the centre, 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 added.

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