Background
Traditionally, the management of recurrent, residual or second primary cancers (ReRuNe) in a previously radiation exposed field includes extensive open surgical techniques such as or mandibulectomy or pharyngotomy. These approaches have established correlations with significant morbidity, prolonged hospital stays and lengthy dependence on tracheostomy and gastrostomy tubes. Transoral robotic surgery (TORS) offers a minimally invasive approach reduces external dissection, improves post-operative recovery and decreases morbidity. The study looks at the effectiveness of this approach in ReRuNe populations and serves to identify the functional, oncological and survival outcomes in this cohort.
Methods
A systematic review of literature was undertaken from databases including PubMed, Embase and Scopus with two independent authors screening titles, abstracts and full texts against the inclusion and exclusion criteria. The search identified 679 studies with 552 remaining after duplicates were removed. After reviewing titles and abstracts, 61 articles were retrieved in full text form. 15 articles were included in the final study and a meta-analysis of proportions was conducted.
Results
Synthesised evidence included 515 patients across the 15 studies with TORS approach demonstrating a 2-year overall survival rate of 73.8% and a 2-year disease free survival rate of 56.1%. The mean tracheostomy decannulation time was a weighted mean of 17.7 days with long term dependence ranging in 0-11.5% of patients. Positive surgical margins were obtained in 19.4% of patients with a pooled complication rate of 32.3%.
Conclusion
TORS is a promising salvage approach in head and neck cancers with similar survival and oncological outcomes whilst improving functional status and post-operative recovery for patients. Studies with further subgroup analysis on types of head and neck cancer, locations and procedures will further improve evidence base for this technique in the ReRuNe cohort.