Long-term outcomes of trans-oral robotic surgery-assisted total laryngectomy for recurrent laryngeal cancers

Chen-Chi Wang; Wen-Jiun Lin; Armando De Virgilio; Shih-An Liu; Sheng-Hwa Chen; Jia-Shiou Liao

doi:10.1093/jjco/hyaa034

Long-term outcomes of trans-oral robotic surgery-assisted total laryngectomy for recurrent laryngeal cancers

Jpn J Clin Oncol. 2020 Jun 10;50(6):653-660. doi: 10.1093/jjco/hyaa034.

Authors

Chen-Chi Wang^{1

2

3

4}, Wen-Jiun Lin⁴, Armando De Virgilio⁵, Shih-An Liu^{1

4}, Sheng-Hwa Chen³, Jia-Shiou Liao^{2

6}

Affiliations

¹ School of Medicine, National Yang-Ming University, Taipei.
² School of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung.
³ Department of Audiology and Speech-Language Pathology, Asia University, Taichung.
⁴ Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung.
⁵ Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy.
⁶ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

PMID: 32236415
DOI: 10.1093/jjco/hyaa034

Abstract

Objective: For recurrent laryngeal cancers, trans-oral robotic surgery has been used to perform total laryngectomy, but limited cases had been reported without long-term outcome follow-up. This study aims at presenting the largest longitudinal retrospective cohort in a single tertiary referral medical center.

Methods: From November 2013 to August 2017, seven patients with recurrent laryngeal cancers without evidence of neck metastasis were selected to receive trans-oral robotic surgery-assisted TL without neck dissection. The para-operative details including the surgical success rates, surgical methods, resection extent, drainage tube placement, pharyngeal wound closure, console surgical time, pathologic findings and long-term complications were reviewed and described. The study end points include survival rates and preservation of swallowing function without tube feeding.

Results: Trans-oral robotic surgery-assisted total laryngectomy was successfully performed on all seven patients with mean surgical console time of 111 ± 66 min. Strap muscles and hyoid bone were resected like open surgery in six and five patients, respectively. For all the seven patients, there was no severe pharyngo-cutaneous fistula formation requiring repair in a second surgery, but tracheostoma stenosis was not uncommon (57%). Three patients received adjuvant chemotherapy/radiotherapy. After follow-up of 36.1 ± 15.8 months, two patients had neck recurrence, and one patient died 19 months after surgery, but the other five patients were alive without disease recurrence. The overall survival rate was 85.7% (6/7), and all patients had good swallowing function without tube feeding.

Conclusions: Trans-oral robotic surgery-assisted total laryngectomy is a feasible approach for selected patients with recurrent laryngeal cancers. The oncologic and functional outcomes were satisfactory. Further larger cohort study is worthwhile to further elucidate the value of trans-oral robotic surgery-assisted total laryngectomy.

Keywords: laryngeal cancer; robotic surgery; swallowing; total laryngectomy; trans-oral.

MeSH terms

Aged
Humans
Laryngeal Neoplasms / pathology
Laryngeal Neoplasms / surgery*
Laryngectomy*
Longitudinal Studies
Male
Middle Aged
Neck Dissection
Neoplasm Recurrence, Local*
Operative Time
Retrospective Studies
Robotic Surgical Procedures*
Treatment Outcome