Oncological and Functional Outcomes of Transoral Robotic Surgery and Endoscopic Laryngopharyngeal Surgery for Hypopharyngeal Cancer: A Systematic Review

Katherine W K Lai; Ronald Lai; Balazs B Lorincz; Chen-Chi Wang; Jason Y K Chan; David C M Yeung

doi:10.3389/fsurg.2021.810581

Oncological and Functional Outcomes of Transoral Robotic Surgery and Endoscopic Laryngopharyngeal Surgery for Hypopharyngeal Cancer: A Systematic Review

Front Surg. 2022 Apr 7:8:810581. doi: 10.3389/fsurg.2021.810581. eCollection 2021.

Authors

Katherine W K Lai¹, Ronald Lai², Balazs B Lorincz³, Chen-Chi Wang⁴, Jason Y K Chan¹, David C M Yeung¹

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong SAR, China.
² Affiliated Teaching Unit of the Chinese University of Hong Kong, Department of Ear, Nose, and Throat, United Christian Hospital, Kwun Tong, Hong Kong SAR, China.
³ Department of ENT, Head, and Neck Surgery, Agaplesion Frankfurter Diakonie Kliniken, Bethanien and Markus Hospitals, Frankfurt am Main, Germany.
⁴ Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.

Abstract

Objectives: Hypopharyngeal carcinoma (HPC) is a head and neck carcinoma with poor prognosis. Traditional laryngopharyngectomy offered promising oncological outcomes at the cost of functional outcomes. The recent advent in transoral robotic surgery (TORS), an organ-preserving surgery, has opened up new perspectives in the treatment for HPC. Here, we evaluate minimally invasive organ preservation surgery [TORS and endoscopic laryngopharyngeal surgery (ELPS)] for HPC in terms of feasibility and oncological and functional outcomes.

Methods: This is a systematic review. Six databases [CUHK Full-Text Journals, Embase 1910 to 2021, Ovid Emcare, Ovid MEDLINE (R), CINAHL, PubMed] were searched for articles and primary studies for TORS and ELPS for HPC. Screening was completed using predefined inclusion or exclusion criteria.

Results: A total of 8 studies on TORS and 3 studies on ELPS were eventually chosen after full-text review. For studies on TORS, 61.3% of patients (84 out of 137) still survived at the last follow-up with a mean follow-up time of 23.20 months (range: 12.8-37.21 months). Severe intraoperative and postoperative complications have not been reported. No cases of TORS required a conversion to open surgery. Swallowing function was optimal postoperatively with only 6 patients eventually required a percutaneous endoscopic gastrostomy (PEG) for feeding. Disease-specific survival was taken as the parameter for the measurement of oncological outcomes. A total of 2 studies reported a disease-specific survival of 100% within their follow-up period of 1 and 1.5 years, respectively. Another 2 studies reported a 2-year DSS of 89 and 98%, respectively. A 5-year DSS of 100% in early stage and 74% in late stage were achieved in one study. Another study also reported a 5-year DSS of 91.7%. For studies of ELPS, a 5- and 3-year disease-specific survival of 100% were achieved in 2 studies. Patients who underwent ELPS had good postoperative swallowing function with no PEG placement. There were also no other fatal complications.

Conclusions: Both TORS and ELPS for HPC provide satisfactory long-term oncological and functional outcomes improving postoperative quality of life of patients.

Keywords: endoscopic laryngopharyngeal surgery; hypopharyngeal carcinoma; laryngopharyngeal carcinoma; transoral robotic surgery; transoral surgery.

Publication types

Systematic Review