Editorial: News and update in transoral robotic surgery in oropharyngeal, hypopharyngeal, and laryngeal cancers

Abstract

Consequently, optimal treatment outcomes can be achieved and less morbidities caused to the patients improves overall quality of life.Transoral Robotic Surgery (TORS) for UADT has been in practice for many years, as early as its inception in early 2000s, where Dr Gregory Weinstein and Dr Bert O'Malley successfully used Da Vinci robotic systems to resect the oropharyngeal tumours [1]. Since then, there have been many scientific studies emerges, try to explore the effectiveness of this method in the practicing institutions worldwide. At present, this TORS technique has been shown to improve the treatment outcomes of selected patients with the UADT tumours. This inclusive of recent studies on the application of TORS in the oropharyngeal and laryngeal surgery. Critically, there are multiple other recent studies investigating the efficacy of TORS in preserving the functions of speech, swallowing and the quality of life of these patients with UADT tumours.Generally, the status of HPV positivity of oropharyngeal carcinoma determines the final mode of treatment strategy. The HPV status also dictates the outcomes and prognosis of patients with oropharyngeal carcinoma. This however may differ within varied geographical locations, because of different tumour biology and patient characteristics. This necessitates other new detailed studies from different continent so that specific treatment outcomes can be measured and translated to local clinical practice. A bigger multi-institution collaborative study is highly desired at this stage, in order to have accurate and better findings that can be relevant for future application.This research topic encompasses use of TORS in 3 main UADT cancers. Specifically, each paper highlights the functional outcomes of TORS. In their systematic review, W. K. Lai et al.compared functional outcomes between TORS and endoscopic pharyngo-laryngeal surgery (EPLS) in patients affected by hypopharyngeal carcinoma. Both surgeries represent new organpreserving surgical techniques that allow patients to achieve better quality of life post-surgical treatment. In particular, the study demonstrated that 136 out of 147 patients, who underwent TORS, didn't have swallowing disorders (dysphagia and/or aspiration). Post-operative bleeding occurred only in 8 cases. Importantly, the rate of post-operative complications was similar between TORS and EPLS, without statistical difference about bleeding and swallowing disorders [2].Additionally, Sano et al. analysed functional outcomes between TORS, EPLS and transoral videolaryngoscopic surgery (TOVS) showing their advantages as minimally invasive surgeries for pharyngeal and laryngeal tumours. All of the three therapeutic techniques have low rate of post-operative complications, such as bleeding and emergency tracheostomy [3]. In particular, several studies included in this review stressed that TORS is related to lower risk of permanent gastrostomy and/or tracheostomy as well as lower rate of positive resection margins than other surgical therapies. These advantages lead to a better quality of life of patients that is one of the main goals of minimally invasive surgery, such as TORS.Another study pointed out the post-operative mortality risk after TORS due to pT1-T2 oropharyngeal squamous cell carcinoma. This retrospective study by Davies et al. revealed that the risk of 30-day post-op mortality was very low (about 0.6%) and that it was higher in elderly patients (over 65 years old) [4]. These results suggest the effectiveness of TORS among the therapeutic protocols in early oropharyngeal cancer taking into account the strict patient selection in terms of oropharyngeal exposure and age. Indeed, the authors argued that these determinants could increase the risk of peri-operative complications and the rate of positive resection margins.Wang et al. studied and analysed the role of TORS for early glottic cancer involving anterior commissure (AC). Indeed, AC represents a tricky laryng