Key points
- Transoral robotic surgery (TORS) for oropharyngeal cancer has been
introduced to ensure better functional preservation with less
morbidity.
- Long-term functional outcomes, including speech and swallowing
outcomes after TORS, were thoroughly investigated in this study.
- We evaluated speech and swallowing function 2-3 years after TORS in 41
patients with oropharyngeal squamous cell carcinoma.
- Long-term speech and swallowing functions after TORS were acceptable
in most patients.
- TORS showed favorable long-term functional speech and swallowing
outcomes.
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.