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Original Investigation Research

Robotic Surgery Alone in Oropharyngeal Cancer

Table 1. Characteristics of the Study Population Characteristic

Figure 1. Trends in 3 Global Quality-of-Life (QOL) Scale Scores Across 24 Months

No. (%)

Patient Male sex

100

HR QOL compared with 1 mo before diagnosis Overall QOL HR QOL in past 7 d

26 (76)

Age, mean (SD), y

59 (8)

80

a

Race

White

32 (94)

60

African American

2 (6)

History

40

Smoking

24 (70) 20 (59)

Mean QOL Score

20

Alcohol use a

Disease Primary site Tonsil

0

16 (47) 15 (44)

1

12 Postoperative Time, mo 6

24

Tongue base Soft palate

8

12

8

9

No. of patients

2 (6) 1 (3)

Pharyngeal wall

related QOL during the past 7 days,” and “overall QOL includ- ingpersonalwell-beingoverthepast7days”)showedatendency toimprovethroughoutfollow-up( Figure1 ).Oneintervalreached statistically significant improvement (“health-relatedQOLdur- ing the past 7 days” 6 months after surgery) (Figure 1B and Table 2 ); improvements were observed in several other do- mains, although thesewerenot statistically significant (Figure 1 and Table 2) compared with 1-month follow-up scores. ScoresfortheQOLdomainsofpain,swallowing,activity,and chewingalsotendedtoimprovethroughoutfollow-up( Figure2 ). Statisticallysignificantimprovementinchewingscoreswasnoted from1 to 12months after surgery ( P = .048) (Figure 2B). A posi- tive trendwas observed for chewing scores over time ( P = .05). Painscoresimprovedfrom1to6months( P = .006)and12months ( P = .01) after surgery (Figure 2C). However, there was no evi- dencethatthemedianpainscorecontinuedtoimproveovertime ( P = .10). Swallowing scores improved from 1 to 6months ( P = .047) and 24months ( P = .048) after surgery (Figure 2D). There wasanoverallpositivetrendinswallowingscores( P = .01).Inad- dition, the median activity score improved over time ( P = .03) (Figure 2A). Noother specific symptomdomains showed statis- tical evidence of improvement or deterioration from 1 month after surgery over time ( Table 3 ). Discussion Increasing recognition of the adverse effects of CRT and their negative effect on QOL has provided the rationale for TORS as a primary treatment modality option for OPSCC. The present study is especially timely in the current era of human papil- loma virus–positive OPSCC, with younger and healthier pa- tients seeking treatment modalities with less long-term treat- ment-relatedmorbidity.Thereis,however,apaucityofliterature describing the long-term QOL of patients who receive TORS Health-related (HR) QOL compared with 1 month before cancer diagnosis, during the past 7 days ( P = .01 at 6 months), and overall QOL, including personal well-being, during the past 7 days. a P < .05 compared with 1 month after surgery.

Extracapsular spread Yes

4 (12)

No

15 (44) 15 (44)

Not evaluated

T category T1

20 (59) 13 (38)

T2 T3

1 (3)

N category N0

13 (38) 16 (47)

N1

N2a N2b

3 (9) 2 (6)

p16 Status Positive

25 (74)

Negative

8 (24)

Not evaluated

1 (3)

Perineural invasion Positive margins

4 (12)

Follow-up The follow-up period for overall survival was defined as the number ofmonths fromthe date of TORS to the date of the last follow-up determined by clinic visit, telephone survey, or death. Mean follow-up for this cohort was 14 months (range, 13 days to 38months; fromMay 1, 2010, to April 30, 2014). Two patients (6%) died during the follow-up period: 1 due to dis- ease and 1 due to a myocardial infarction. There were no in- traoperative complications. Two patients (6%) required tem- porary gastrostomy tube placement, but no patients required tracheostomy. Among all the completed UW-QOL forms, 4 forms were completed preoperatively, 8 at 1 month after sur- gery, 12 at 6 months, 8 at 12 months, and 9 at 24 months. Quality of Life The scores for the 3 global QOL survey questions (“health- related QOL compared to 1 month before cancer,” “health- 1 (3) a History of alcohol use was defined as any “regular use of alcohol” on the self-reported University of Washington Quality of Life, version 4, survey.

(Reprinted) JAMA Otolaryngology–Head & Neck Surgery June 2015 Volume 141, Number 6

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