Robotic surgery improves survival in early-stage oropharyngeal cancer: JAMA
Los Angeles, California: Transoral robotic surgery may improve surgical outcomes and survival in early-stage oropharyngeal cancer patients as compared to nonrobotic surgery, suggests a recent study in the journal JAMA Oncology.
Despite limited comparative data, the use of transoral robotic surgery has been widely adopted since its approval by the US Food and Drug Administration in December 2009. Anthony T. Nguyen, Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, and colleagues compared the long-term outcomes of transoral robotic surgery with those of nonrobotic surgery for patients with early-stage oropharyngeal cancer.
Retrospective cohort comparative effectiveness analysis was conducted of patients in the National Cancer Database with clinical T1 and T2 oropharyngeal squamous cell carcinoma diagnosed between January 1, 2010, and December 31, 2015, who underwent definitive robotic and non-robotic surgery. To adjust for patient- and disease-related covariates, the researchers performed propensity score matching and multivariable Cox proportional hazards regression analysis. Survival after nonrobotic and robotic surgery was compared in 3 unrelated cancers -- cervical, endometrial, and prostate cancer. The primary outcome was overall survival.
9745 patients (7652 men [78.5%]; mean [SD] age, 58.8 [9.6] years) were selected for the study, of which 2694 (27.6%) underwent transoral robotic surgery.
Key findings of the study include:
- There was a significant increase in the use of robotic surgery from 18.3% to 35.5% of all surgical procedures for T1 and T2 oropharyngeal cancers from 2010 to 2015.
- Robotic surgery was associated with lower rates of positive surgical margins (12.5% vs 20.3%) and lower use of adjuvant chemoradiotherapy (28.6% vs 35.7%).
- Among 4071 patients with known human papillomavirus status, robotic surgery was associated with improved overall survival compared with nonrobotic surgery in multivariable Cox proportional hazards regression (hazard ratio [HR], 0.74).
- Similar results were seen when analyzing only the subset of facilities offering both robotic and nonrobotic surgery.
- The 5-year overall survival was 84.8% vs 80.3% among patients undergoing robotic vs nonrobotic surgery in propensity score–matched cohorts.
- There was no evidence that robotic surgery was associated with improved survival in other cancers, such as prostate cancer (HR, 0.92), endometrial cancer (HR, 0.97), and cervical cancer (HR, 1.27).
"Our results suggest that transoral robotic surgery was associated with improved surgical outcomes and survival compared with nonrobotic surgery in patients with early-stage oropharyngeal cancer. Evaluation in comparative randomized trials is warranted," concluded the authors.
The study, "Comparison of Survival After Transoral Robotic Surgery vs Nonrobotic Surgery in Patients With Early-Stage Oropharyngeal Squamous Cell Carcinoma," is published in the journal JAMA Oncology.
