3 RESULTS
The mean age of the 41 patients was 57.7 ± 9.9 years and the male to
female ratio was 34:7. The most common subsite was the palatine tonsil
(30 cases), followed by the base of tongue (9 cases). Pathologic testing
confirmed that 38 (92.7%) were squamous cell carcinomas and 3 were
basaloid squamous cell carcinoma. Nineteen out of 26 patients (73.1%)
were p16 positive. According to the 8th version of the
American-Joint Cancer Classification (AJCC) staging
system,22 the number of T1/T2/T3/T4 patients was
17/23/1/0, the number of N0/N1/N2 patients was 12/19/10 and the number
of stage I/II/III/IV patients was 7/3/19/12. Forty patients (97.6%)
underwent neck dissection concomitant with TORS. Tracheostomy was
performed on six (14.6%) TORS patients. The mean time of console work
for TORS was 94.7 ± 41.5 min. There were 1 case of minor hematoma and 6
cases of seroma in the neck. None of the cases was converted to
conventional surgery. Thirty-six patients (87.8%) received adjuvant
radiation or chemoradiation therapy (Table 2).
We defined the abnormal cut-off values for tongue motility, maximal
phonation time, verbal diadochokinesis, articulation tests, and reading
speed as two standard deviations above or below the value of normal
subjects (Table 3).
The mean tongue motility score was 15.5 ± 1.2 (range, 13 – 17) in this
study. Only 3 patients had abnormal tongue motility scores below the
cut-off value defined in the study (below 14.58). The mean maximum
phonation time was 17.8 ± 6.9 sec (range, 9.2 – 35.7) in this study. No
patient was lower than the abnormal cut-off value.
The mean articulation score was 5.9 ± 0.3 (range, 5 – 6) in this study.
No patient showed an abnormal cut-off value score (lower than 4.79). The
mean verbal diadochokinesis score (sum of regularity and accuracy) was
25.1 ± 2.1 in this study, which was higher than the abnormal reference
value (< 21.83). The mean reading speed was 11.9 ± 2.3 sec
(range, 9.1 – 15.8) in this study. All patients were below the abnormal
cut-off value score (higher than 18.2 sec).19
In the subgroup analysis of articulation and speech outcomes according
to primary site and T classification, there were no significant
differences between the tonsil and base of tongue and between T1 and T2
primary cancers (Table 4).
MBS was performed in 32 patients. Generally, the results of MBS were
favorable in all patients. However, in the oral stage, mild
piecemeal deglutition was noted in
3 patients, premature bolus loss in 8 patients, and presence of mouth
residue in 3 patients. Reduced laryngeal elevation and epiglottic
closure and repeated swallowing were seen in only 2 patients in the
pharyngeal stage. In the esophageal stage, delayed passage was noted in
7 patients, opening of pharyngoesophageal segment in 4 patients, and
gastroesophageal reflux in 4 patients (Table 5). None of the patients
needed nasogastric or PEG tubes before adjuvant therapy. However, one
patient (2.4%) with T2 tonsil cancer required permanent PEG tube
placement after chemoradiation therapy. No patients required permanent
tracheostomy.