Experience with the introduction of Transoral Robotic Surgery (TORS) at an oncologic hospital of the Brazilian Unified Public Health System (SUS)

摘要

Introduction: Transoral Robotic Surgery (TORS) has emerged for treatment of oropharyngeal and supraglottic larynx tumors due to the increase of oropharyngeal cancer caused by HPV. Objective: To demonstrate the oncological results achieved with this technology. Methods: The study was retrospective, with 132 cases of patients submitted to TORS at our institution – 101 men and 31 women; 114 malignant. 65 patients in the malignant group received TORS as first-line treatment, and 44, as salvage treatment; 5 patients were excluded due to another treatment option. 10.61% of patients presented complications – the most common was bleeding. However, only 3 patients had to be reoperated. The mean time of enteral tube use was 14.2 days, and the mean time of tracheotomy was 29.77 days. By the end of the study, all patients had been dependent on enteral tube and tracheotomy. The mean time of hospitalization was 4.5 days; the mean total time of surgery was 65.4 minutes – 19.6 for docking and set-up, and 45.8 for console operation. Results: Among a total of 132 surgeries, our complication rate was of 10.61%, whereas 3 patients required reoperation. All patients had the enteral catheter and tracheotomy removed. The overall survival of patients submitted to TORS as first-line treatment was 86.2%, and disease-free survival, 83.0%. Among patients undergoing robotic surgery as salvage therapy, the overall survival was of 51.5%, and disease-free survival in the same period, of 42.2%. Conclusion: TORS is safe and it is usually possible to obtain negative surgical margins for malignant oropharyngeal and supraglottic larynx tumors. Use of this treatment was successfully introduced in a public hospital in Brazil.