Robotic surgery promising for head/neck cancer

Researchers from Mount Sinai School of Medicine presented the outcomes of robotic surgery in tobacco users with head and neck cancer at the American Head and Neck Society annual meeting, which was held July 21-25 in Toronto.

In a retrospective study of 35 smokers and 22 nonsmokers who were treated with transoral robotic surgery (TORS) and evaluated after 19.9 months, Mount Sinai researchers found that progression-free survival was 91% and 96% and overall survival was 97% and 100% for the smoking and nonsmoking groups, respectively. They also found that 94% and 96% of tumors removed using robotic surgery did not come back in the smoking and nonsmoking groups, respectively; in addition, the surgery prevented metastasis in 97% and 100% of these patients.

The group's analysis shows that robotic surgery is highly effective in treating these patients and should be considered as a primary treatment modality, said Dr. Chaz Stucken, chief resident, otolaryngology, at the medical school.

Another study also showed that TORS resulted in positive survival outcomes in patients with head and neck cancer, according to a presentation from Dr. John de Almeida, who conducted the research as an otolaryngology fellow at Mount Sinai. In this retrospective analysis, Dr. de Almeida and his team evaluated 237 patients treated with TORS. Of this group, 26% received adjunctive radiotherapy and 32% received adjunctive chemotherapy. Two-year disease-specific survival and overall survival were 94% and 98%, respectively, and 21 patients experienced a recurrence.

Finally, in a third study, researchers set out to determine whether the number of metastatic lymph nodes, a well-established measure of disease severity in the more typical tonsil cancer patient with a history of smoking and/or drinking, applies to human papillomavirus (HPV)-positive tonsil cancer. They evaluated 1,515 patients from the pre-HPV era (1988-1997) and 5,139 patients from the HPV-predominant era (1998-2007), all from the Surveillance, Epidemiology, and End Results database. The group found that while metastatic lymph nodes are still important in informing prognosis, their significance is diminished since HPV has become a predominant cause of cancer.

Study co-author Dr. Andrew Sikora, an assistant professor of otolaryngology, noted the need for new ways to assess disease prognosis in light of the study's results, which also provided further evidence that HPV-positive head and neck cancer is a distinct disease.

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