Key points
INTRODUCTION
The incidence of oropharyngeal cancer, especially human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), is increasing worldwide.1 HPV-positive OPSCC has better treatment outcomes and prognoses compared to HPV-negative cancer because HPV-positive OPSCC generally occurs in younger patients who are more likely to survive longer. Therefore, preservation of function and reduction of morbidity are more critical in treating HPV-positive patients.
The primary treatment for oropharyngeal cancer has been radical excision of the primary tumor using various approaches and subsequent adjuvant radiation treatment. This treatment strategy results in inevitable functional disturbance, especially in speech and swallowing.2 Therefore, based on some landmark studies, organ preservation chemoradiation therapy has been developed and confirmed to be comparable to surgical treatment in avoiding surgical morbidity and functional loss.3,4 Since then, chemoradiation therapy has been considered the primary treatment for oropharyngeal cancer.
However, long-term results of chemoradiation therapy in treating head and neck cancer were reported, and high dose chemoradiation therapy resulted in significant short- and long-term morbidities such as xerostomia and dysphagia.5-7 A systematic review showed that 10-30% of patients require gastrostomy one year after treatment. This results in a significantly adverse impact on quality of life.8 Therefore, functional preservation, not merely organ preservation, are important; and treatment outcome and quality of life and function need to be considered when selecting a treatment strategy.
Transoral robotic surgery (TORS) for oropharyngeal cancer was introduced as an option with better functional preservation with less morbidity, and TORS was approved by the United States Food and Drug Administration in 2009.
Oncologic outcomes of TORS for oropharyngeal cancer are comparable to those of primary chemoradiation or radical surgery.9In terms of functional outcome, TORS showed excellent short-term results, including more rapid recovery of swallowing, shorter hospitalization, and shorter operation time.10-12However, the actual long-term functional outcomes of TORS, including speech and swallowing outcomes, have not been thoroughly investigated, but some studies did evaluate long-term functional outcomes of tracheostomy, feeding tube dependency, and questionnaire-based subjective results after TORS.13-18 Therefore, this study aimed to evaluate long-term functional speech and swallowing outcomes after TORS for oropharyngeal cancer.