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Original Investigation Research

Robotic Surgery Alone in Oropharyngeal Cancer

Table 3. Symptom-Specific QOL Domains

Postsurgery QOL Score, Median (IQR) a 1 Month 6 Months

QOL Domain Patients, No.

12 Months

24 Months

Activity

63 (50-88)

75 (50-100)

100 (75-100)

.03 b

P value

.43

.10

Anxiety

70 (30-70)

70 (70-100)

85 (50-100)

70 (70-100)

P value

.19

.37

.33

Appearance

88 (75-100)

100 (75-100)

P value

.35

.67

>.99

Chewing

50 (50-100)

100 (50-100)

100 (100-100)

<.05 b

P value

.40

.11

Mood

75 (75-100)

75 (50-100)

100 (75-100)

75 (75-100)

P value

.66

.45

.83

Pain

38 (25-75)

88 (75-100)

100 (75-100)

75 (75-75)

<.01 b

.01 b

P value

.06

Recreation

75 (63-100)

88 (75-100)

100 (88-100)

100 (75-100)

P value

.45

.20

.40

Saliva

85 (70-100)

100 (70-100)

70 (70-100)

P value

.85

.55

.75

Shoulder function

85 (70-100)

85 (30-100)

100 (85-100)

100 (30-100)

Abbreviations: IQR, interquartile range; QOL, quality of life. a Quality-of-life scores were compared with QOL scores at 1 month after baseline using the Wilcoxon Mann-Whitney test. No adjustments were made for multiple testing. b Statistically significant at P < .05.

P value

.71

.43

.67

Speech

100 (85-100)

100 (70-100)

100 (85-100)

100 (100-100)

P value

.25

>.99

.51

Swallowing

70 (30-85)

100 (70-100)

.05 b

P value

.07

Taste

100 (50-100)

70 (70-85)

100 (70-100)

P value

.43

.86

>.99

long-term follow-up (chewing: P = .048 at 12 months; swal- lowing: P = .047 at 6months and stable at 24months; P = .048), confirming a previous finding in a small number of patients receiving TORS alone. 9 This recovery is not unexpected; pre- vious studies 8-11,16,17 suggested that RT and CRT cause sub- stantial deterioration in short-term and long-term patient- perceived swallowing function, with slow recovery. Our study included 2 patients (6%) who had recurrences, both of whom did not adhere to recommendations for adju- vant therapy. These patients demonstrated high-risk fea- tures after TORS (extracapsular spread, positivemargin, or peri- neural invasion); adjuvant therapywas recommended, but the patients declined. At a 2-year follow-up, 1 patient demon- strated regional failure, and 1 had both local and regional fail- ure. None of the 34 patients experienced distant metastasis or failure in the retropharyngeal nodal basin. The patient with lo- cal and regional failure showed a sharp decrease of QOL score, but the other patient with regional failure maintained a high QOL score at the time of recurrence. Overall, excluding these 2patientsdidnot affect the statistical significanceofQOL scores found in our original analysis. Our patients had a good rate of survival throughout the 2-year follow-upperiod. Basedon scores for the 2 global health- related QOL items, patients experienced a trend toward in- creasing health-related QOL during 2 postoperative years. At the 6-month follow-up evaluation, significant improvement inhealth-relatedQOLover the past 7 dayswas recognized com-

It is especially notable in our study that speech function wasminimallyaffected 1monthafter surgery, andpatientswere able tomaintain similar levels of function throughout follow- up. A similar result was reported for patients with OPSCC treated with TORS alone by Leonhardt et al, 9 although with smaller numbers (N = 9). This minimal effect on speech only in patients who underwent surgery is not surprising since studies 9,10 have shown that adjuvant RT is significantly cor- relatedwith lower speech function and speech attitude scores at 12 months following TORS. To our knowledge, the present study is the first to report a statistically significant improvement inpain in the short term with lasting long-termrelief amongpatientswhoundergoTORS without adjuvant therapy. Pain scores at 1 month were ini- tially low (mean score, 47), but they improved at 6 months (mean score, 83) ( P = .006) and remained stable at 12months. This finding is in contrast to that in patients who received ad- juvant therapy after TORS and experienced a significant de- terioration at 6months in the bodily pain domain of the Short Form 8 Health Survey. 9 It appears that the addition of RT or CRT following TORS hampers recovery from pain associated with surgery, but TORS alone is associatedwith short-termpain and good long-term recovery. Similarly, patients reported relatively low scores in chew- ing and swallowing at 1month following surgery (median score, 50 and 70, respectively). This difficulty was followed by sta- tistically significant recovery to a higher level of functionwith

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

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