Chinese journal of otorhinolaryngology head and neck surgery最新文献

Objective: To explore the safety, effectiveness, and short-term outcomes of transoral robotic surgery (TORS) for supraglottic laryngeal cancer. Methods: A retrospective analysis was conducted on patients with supraglottic laryngeal cancer who underwent TORS at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Eye Ear Nose and Throat Hospital of Fudan University, and the First Affiliated Hospital of China Medical University between January 2018 and April 2024. Data on operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheostomy, nasogastric feeding, complications, and short-term follow-up were analyzed. Statistical analysis was performed using Python. Results: A total of 27 patients with supraglottic laryngeal cancer were included from the four centers, including 24 males and 3 females, with a median age of 66 (65, 68) years [M(Q₁, Q₃), same below]. There were 26 cases of squamous cell carcinoma and 1 case of adenoid cystic carcinoma.The TNM staging included T1 in 10 cases (37.04%), T2 in 13 cases (48.15%), and T3 in 4 cases (14.81%); N0 in 14 cases (51.85%), N1 in 7 cases (25.93%), and N2 in 6 cases (22.22%). The Da Vinci Si system was used in 23 cases, and the Da Vinci Xi in 4 cases. The robotic surgical time was 53 (30, 58) min. Concurrent neck dissection was performed in 25 cases, neoadjuvant therapy was given preoperatively in 8 cases (29.63%), and postoperative radiotherapy was administered in 13 cases (48.15%). Tracheostomy was performed in 11 cases (40.74%). Nasogastric tube placement was required in 23 cases (85.19%), with a median duration of 16 (12, 21) days. The postoperative hospital stay was 9.19±4.07 days. The median follow-up time was 12 (3, 30) months. Local recurrence occurred in 2 cases. The 3-year overall survival rate was 100%, and the 3-year disease-free survival rate was 94.1%. Conclusion: With appropriate patient selection, TORS for supraglottic laryngeal cancer demonstrates satisfactory short-term outcomes, offering advantages in safety, efficacy, and minimal invasiveness. It can be considered a new treatment option for this condition.

Objective: To investigate the efficacy and feasibility of transoral robotic surgery (TORS) for resection of tumors in the parapharyngeal spaces. Methods: The clinical data of 57 patients who underwent TORS for parapharyngeal space tumors from September 2018 to February 2024 were retrospectively analyzed. These patients were treated at five medical institutions: The First Affiliated Hospital of China Medical University, Eye & ENT Hospital of Fudan University, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and Sun Yat-sen University Cancer Center. The patients were 28 males and 29 females, aged 17-77 years (median age, 47 years). The pathological types, locations, and sizes of the tumors, operation time, intraoperative bleeding volumes, postoperative hospital stays, and postoperative complications were evaluated. The data were analyzed using SPSS 27.0 software. Results: Postoperative pathological examination revealed 11 types of benign tumors. Among 57 cases, 27 cases had their tumors in the prestyloid spaces, predominantly with pleomorphic adenoma (n=17), and 30 cases in the retrostyloid spaces, predominantly with schwannoma (n=22). The tumor volumes ranged from 0.6 to 130.1 cm³, the intraoperative bleeding volumes ranged from 5 to 1 000 ml, the operation time ranged from 20 to 390 min, and the postoperative hospital stays ranged from 2 to 25 days. The total costs for individual cases were 36 000-100 000 yuan, with the highest cost in the case suffering from cerebrovascular accident. Four patients(7.0%) had tracheotomy and 36(63.2%) had nasogastric tube placement. Among the 57 patients, 5 had postoperative cavity effusion, 2 had wound dehiscence, 2 had cerebrovascular accidents, 1 had Horner syndrome, and 2 had other complications. The patients were followed up for 1-67 months, with only 1 case of recurrence in the patient with intracranial and extracranial communication. Conclusion: TORS is a safe and feasible approach for treating parapharyngeal space tumors, offering advantages such as minimal invasiveness, reduced blood loss, and faster recovery. It is suitable for parapharyngeal space tumors of various pathological types and locations. The postoperative complications are manageable, with favorable long-term follow-up results and low recurrence rates.

Objective: To evaluate the clinical efficacy of transoral robotic surgery (TORS) in the treatment of malignant tongue base tumors. Methods: A multicenter study was conducted to collect and analyze the clinical data of patients with malignant tongue base tumors who underwent TORS between January 2017 and January 2023 at five otolaryngology-head and neck surgery centers in China, including Eye Ear Nose and Throat Hospital of Fudan University, Sun Yat-sen University Cancer Center, Tongji Hospital of Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, and the First Affiliated Hospital of China Medical University. Among the patients, 38 were males and 11 were females, with a mean age of 59.0±8.8 years. Baseline characteristics, complications, and follow-up data were compared between groups. Independent sample t-tests or Mann-Whitney U tests were used for comparisons of continuous variables; chi-square tests or Fisher's exact tests were applied for categorical variables. Survival analysis was performed using the Kaplan-Meier method to calculate overall survival and disease-free survival, with differences between groups compared using the log-rank test. Results: Among the 49 patients, 41 (83.7%) were diagnosed with squamous cell carcinoma (SCC), with a p16 positivity rate of 51.2% (21/41). There were no statistically significant differences between the p16-positive group (n=21) and the p16-negative group (n=20) in age, sex, or postoperative bleeding (all P>0.05). However, there was a significant difference in TNM stage between the two groups (χ²=14.556, P=0.020), with the p16-positive group predominantly in stage I (66.7%) and the p16-negative group primarily in stages Ⅲ and Ⅳ (40.0% and 30.0%, respectively). The postoperative tracheotomy rate was 30.6% (15/49), and the incidence of postoperative bleeding was 6.1% (3/49). The 1-year and 3-year overall survival rates were 98.0% and 92.5%, respectively, while the 1-year and 3-year disease-free survival rates were 89.2% and 84.9%, respectively. No significant differences were observed between the p16-positive and p16-negative groups in 3-year overall survival (100% vs. 83.8%, χ²=1.093, P=0.518) or 3-year disease-free survival (68.2% vs. 88.9%, χ²=2.161, P=0.382). Conclusion: TORS for malignant tongue base tumors demonstrates high clinical safety and favorable oncological outcomes.

Objective: To summarize preliminary experience and outcomes of transoral robotic surgery (TORS) in hypopharyngeal cancer. Methods: Clinical data of 28 patients with hypopharyngeal cancer underwent TORS with Da Vinci Si or Xi surgical system from Sep 2017 to Mar 2024 in three medical centers(Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University and Eye&ENT Hospital of Fudan University) in China were respectively analyzed. All patients were males, aged from 47 to 82(62.5±7.1) years old. According to TNM staging of AJCC, the stages included T1 in 6 cases, T2 in 17 cases, T3 in 3 cases and T4 in 2 cases; N0 in 18 cases, N1 in 3 cases, N2 in 6 cases, N3 in 1 case. SPSS version 26 was applied, and with Kaplan-Meier surviving curves, overall survival, local control rate and disease-free survival for those patients were calculated. Results: All 28 patients underwent successfully their TORS, no any case with transfer opening or positive surgical margin. Two patients died within one month after surgery. Two patients experienced minor oral bleeding, and subsenquently was cured. The follow-up period ranged from 1 to 81 months with an average of 24.8 months, in which five patients(17.9%) died, five patients(14.3%) experienced local recurrence and four patients had distant metastases. The three year overall survival, local control rate and disease-free survival were 77.1%, 74.6% and 57.1%, respectively. Conclusion: In proper selected cases of hypopharyngeal cancer, TORS can offer acceptable survival and local control rates and it can be considered as a new useful option for the surgery of hypopharyngeal cancer.

Objective: To evaluate the safety, and feasibility of transoral robot-assisted retropharyngeal lymph node (RPLN) dissection. Methods: Clinical data of head and neck cancer patients who underwent transoral robot-assisted RPLN dissection from December 2017 to March 2024 at the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, and Sun Yat-sen University Cancer Centre were retrospectively analyzed. A total of 35 patients(22 males, 13 females, aged 47.4±13.4 years old) with retropharyngeal lymph node metastases from head and neck cancer, including 20 cases of nasopharyngeal cancer, 9 cases of thyroid cancer, 2 cases of salivary adenocarcinoma, 2 cases of tonsil cancer and 2 cases of hypopharyngeal cancer. Operation time, intraoperative bleeding and complications, postoperative nasogastric tube retention time, hospital stay and complications were evaluated. Statistical analysis was performed using SPSS 22.0 software. Results: All patients successfully received transoral robot-assisted RPLN dissection without intermediate open surgery, with removals of 2 (1, 3) RPLNs. The total operation time was 130 (102, 210) minutes. The intraoperative bleeding was 50 (20, 100) ml, and there was no major bleeding or organ damage during the operation. Prophylactic tracheotomy was performed in 8 cases, and postoperatively nasogastric tubes were left in 22 patients, with retention time of 10.5 (7.5, 14.0) days. Postoperative hospital stay was 5 (4, 9) days. Postoperative complications included incision dehiscence in 4 cases and dysphagia in 4 cases. The median postoperative follow-up was 23.4 months, with progression or recurrence in 5 patients, including regional recurrence in 3 patients, lung metastasis in 1 patient, and bone metastasis in 1 patient. The 2-year regional failure-free survival and disease-free survival rates were 91.43% and 85.71%, respectively. Conclusion: Transoral robot-assisted RPLN dissection is a safe and feasible surgical method with less trauma, fewer complications, and higher safety. Patients need to be carefully selected at the initial stage of application.

Objective: To share our experience of single-port transoral Da Vinci robotic surgery for laryngeal and pharyngeal benign tumors. Methods: Three patients aged over 18 years and diagnosed respectively with epiglottic cyst, aryepiglottic fold cyst and thyroglossal duct cyst at tongue base were included who received operations in Hainan Hospital of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine (Boao Research Hospital of Hainan) between 1 August 2023 and 10 April 2024. There were 1 male and 2 females, with a average age of 59 years old. The clinical diagnosis of these 3 patients was respectively epiglottic cyst, aryepiglottic fold cyst and thyroglossal duct cyst at tongue base. Intraoperative conversion rate, blood loss, operation time, hospital stay, pain score and swallowing function score were analyzed. Results: All three patients successfully underwent the operations with the single-port Da Vinci robotic system. The clean-contaminated resection rate of the tumors was 100%. The conversion rate was 0. The blood loss was 0-7 ml. The operation time was 5-30 minutes. There were no adverse events such as loosening of teeth and soft tissue abrasions of pharyngeal side wall. The rate of oral feeding within 24 hours after surgery was 100%. No postoperative coughing, bleeding, or dyspnea occurred. The average length of hospital stay was 3.7 days. The VAS score decreased 3 days after surgery compared to 1 day after surgery. The swallowing function recovered 1 month after surgery. Conclusion: The single-port transoral robotic surgery for laryngeal and pharyngeal benign lesions is safe and efficient, and has few complications.

Objective: To explore the clinical application value of transoral robotic surgery (TORS) in the treatment of tonsil squamous cell carcinoma (TSCC). Methods: A retrospective analysis was conducted. The clinical data of 157 TSCC patients were collected who received TORS at five medical centers, namely the Sun Yat-sen University Cancer Center, Sun Yat-sen Memorial Hospital, Eye Ear Nose and Throat Hospital of Fudan University, the First Affiliated Hospital of China Medical University, and Tongji Hospital of Tongji Medical College, from 1 January 2017 to 31 July 2022. There were 130 males and 27 females, aged 24-85 years. All patients were followed-up at least for 2 years (2-year group), among them, 99 patients had a follow-up of 3 years (3-year group). The overall survival (OS), progression-free survival (PFS), clinical stage, human papillomavirus (HPV) infection status were analyzed. SPSS 25.0 and SAS 9.4 were used for statistical analysis. Results: The OS and PFS of the 2-year group were 91.7% and 87.9%, respectively. The OS and PFS of the 3-year group were 85.9% and 82.8%, respectively. The prognosis of patients with locally early-stage was better than that of locally advanced patients, with the OS of 94.4% for T1-2 vs. 78.0% for T3 (P=0.005) and the PFS of 91.2% for T1-2 vs. 75.0% for T3 (P=0.011) in the 2-year group; the OS of 91.1% for T1-2 vs. 65.0% for T3 (P=0.004) and the PFS of 88.6% for T1-2 vs. 60.0% for T3 (P=0.002) in the 3-year group; and also the OS of 90.0% for stage Ⅰ-Ⅱ vs. 79.5% for stage Ⅲ-Ⅳ (P=0.204) and the PFS of 86.7% for stage Ⅰ-Ⅱ vs. 76.9% for stage Ⅲ-Ⅳ (P=0.188) in the 3-year group. The prognosis of HPV-positive TSCC patients was better than that of HPV-negative patients in the 3-year group, with the OS of 90.9% for HPV-positive vs. 80.5% for HPV-negative (P=0.045) and the PFS of 90.9% for HPV-positive vs. 75.6% for HPV-negative (P=0.047). The average time of postoperative tracheal cannula indwelling was 25.1 days. The indwelling rate and average indwelling time of the postoperative nasogastric tube were 94.3% (148/157) and 8.5 days, respectively. Conclusion: TORS has outstanding survival benefits for TSCC patients. HPV-positive TSCC patients have a better prognosis than HPV-negative patients. TORS treatment of TSCC patients has advantages in postoperative recovery and quality of life.