Dr. Allen Cheng, Dr. Ashish Patel, Dr. Eric Dierks and Dr. R. Bryan Bell from our team at Head + Neck Surgical Associates, have authored the following article highlighting the positive results of patients who underwent transoral robotic surgery (TORS) and neck dissection with risk-adapted therapy. Below are their findings and a brief synopsis of the study:
Methods
We retrospectively identified 122 patients with HPV-positive oropharyngeal carcinoma treated with TORS and neck dissection between 2011 and 2018. Survival probability was calculated. We determined the effect of the type of neck dissection performed (modified radical neck dissection-MRND vs. selective neck dissection – SND), extranodal extension (ENE), margin status, and presence of ≥ 5 metastatic nodes on survival.
Results
Our patient population had a five-year overall survival of 91.0% (95% C.I. 85–97%). The five-year probability of recurrence or cancer-associated death was 0.0977 (95% C.I. 0.0927–0.1027). The five-year probability of cancer-associated death was 0.0528 (95% C.I. 0.048–0.0570). All patients who died of their disease had distant metastasis. Our PEG dependence rate was 0%. Patients with ENE and positive margins who underwent adjuvant chemoradiation did not have worse survival. Presence of ≥ 5 metastatic nodes portended worse survival after controlling for age, positive ENE and margins. Low yield (<18 nodes) on neck dissection worsened DFS on multivariable analysis. Furthermore, patients who underwent SND did not have worse OS than those who underwent MRND.
Conclusion
Our study demonstrates that surgery could be simplified by performing TORS with SND rather than MRND. The one true poor prognostic factor in HPV-positive oropharyngeal carcinoma patients who undergo surgery is high nodal burden. Patients with high nodal burden are much more likely to die from their disease.
Resources: Offical Article Located HERE.
