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Research Original Investigation

Robotic Surgery Alone in Oropharyngeal Cancer

T2; 97%), light nodal burden (category N0-N1; 85%) and few high-risk features (12%, extracapsular spread; 3%, positivemar- gin; and 12%, perineural invasion). Although this cohort was comparable to that reported in a previous review of patients who underwent only TORS, 18 it should be noted that our pa- tients had amuch smaller percentage of T3/T4 tumors andN3 disease compared with previously reported CRT series. 18,19 Conclusions Optimizing posttreatment QOL for patientswithhead andneck cancer is important in early T-stage disease with good prog- nosis. Our study suggests that appropriately selected pa- tients who undergo TORS alone for OPSCC experience accept- able short- and long-term QOL outcomes.

pared with 1 month after surgery ( P = .01). No significant de- cline in QOL was noted at any time during the follow-up pe- riod. None of the patients required tracheostomy, and only 2 patients required transient gastrostomy tube at any time point. Our study has limitations. Although this cohort included 34 patients, fewer individual patients (8-12 patients per time point) providedUW-QOL responses at eachpostoperative visit. Because of this small cohort and the large number of compari- sons, there exists the possibility that some of the statistical sig- nificance that was achieved could have been by chance. Simi- larly, the QOL scores were compared in a pooled fashion and not on an individual basis. There was also no comparison arm for patients who received adjuvant CRT after TORS, which would have allowed direct evaluation of the effect of adju- vant therapy on QOL in patients who undergo TORS. The pa- tients included in our study had early T category (category T1-

2 . Logan RM. Advances in understanding of toxicities of treatment for head and neck cancer. Oral Oncol . 2009;45(10):844-848 . 3 . Moore EJ, Olsen SM, Laborde RR, et al. Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc . 2012;87 (3):219-225 . 4 . White HN, Moore EJ, Rosenthal EL, et al. Transoral robotic-assisted surgery for head and neck squamous cell carcinoma: one- and 2-year survival analysis. Arch Otolaryngol Head Neck Surg . 2010;136(12):1248-1252 . 5 . Weinstein GS, Quon H, Newman HJ, et al. Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg . 2012;138(7):628-634 . 6 . Moore EJ, Hinni ML. Transoral laser microsurgery and robotic-assisted surgery for oropharynx cancer including human papillomavirus-related cancer. Int J Radiat Oncol Biol Phys . 2013;85(5):1163-1167 . 7 . Carpenter TJ, Kann B, Buckstein MH, et al. Tolerability, toxicity, and temporal implications of transoral robotic surgery (TORS) on adjuvant radiation therapy in carcinoma of the head and neck. Ann Otol Rhinol Laryngol . 2014;123(11):791-797 . 8 . Hurtuk AM, Marcinow A, Agrawal A, Old M, Teknos TN, Ozer E. Quality-of-life outcomes in transoral robotic surgery. Otolaryngol Head Neck Surg . 2012;146(1):68-73 . 9 . Leonhardt FD, Quon H, Abrahão M, O’Malley BW Jr, Weinstein GS. Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck . 2012;34(2):146-154 . 10 . Dziegielewski PT, Teknos TN, Durmus K, et al. Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg . 2013;139(11): 1099-1108 . 11 . Durmus K, Patwa HS, Gokozan HN, et al. Functional and quality-of-life outcomes of transoral

ARTICLE INFORMATION Submitted for Publication: October 2, 2014; final revision received January 27, 2015; accepted February 15, 2015. Published Online: April 2, 2015. doi: 10.1001/jamaoto.2015.0347 . Author Contributions: Drs Choby and Duvvuri had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Choby, Ferris, Duvvuri. Acquisition, analysis, or interpretation of data: J. Kim, Ling, Abberbock, Mandal, S. Kim, Ferris. Drafting of the manuscript: Choby, J. Kim, Ling, Abberbock, Mandal, Ferris. Critical revision of the manuscript for important intellectual content: Choby, J. Kim, Ling, Abberbock, Mandal, S. Kim, Duvvuri. Statistical analysis: Choby, J. Kim, Abberbock, Ferris. Obtained funding: Ferris, Duvvuri. Administrative, technical, or material support: Mandal, S. Kim, Ferris, Duvvuri. Study supervision: Mandal, Ferris, Duvvuri. Conflict of Interest Disclosures: None reported. Funding/Support: This work was funded in part by the Department of Veterans Affairs Career Development Award and the PNC Foundation (Dr Duvvuri). Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Disclaimer: This manuscript does not represent the views of the US government or the Department of Veterans Affairs. REFERENCES 1 . Chen AY, Schrag N, Hao Y, Stewart A, Ward E. Changes in treatment of advanced oropharyngeal cancer, 1985-2001. Laryngoscope . 2007;117(1):16-21 .

robotic surgery for carcinoma of unknown primary. Laryngoscope . 2014;124(9):2089-2095 . 12 . Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller EA Jr. The addition of mood and anxiety domains to the University of Washington Quality of Life scale. Head Neck . 2002;24(6):521-529 . 13 . El-Deiry MW, Futran ND, McDowell JA, Weymuller EA Jr, Yueh B. Influences and predictors of long-term quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg . 2009; 135(4):380-384 . 14 . Li Y, Taylor JM, Ten Haken RK, Eisbruch A. The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys . 2007;67(3): 660-669 . 15 . Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck . 2008;30 (2):148-158 . 16 . Sinclair CF, McColloch NL, Carroll WR, Rosenthal EL, Desmond RA, Magnuson JS. Patient-perceived and objective functional outcomes following transoral robotic surgery for early oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg . 2011;137(11):1112-1116 . 17 . Tschudi D, Stoeckli S, Schmid S. Quality of life after different treatment modalities for carcinoma of the oropharynx. Laryngoscope . 2003;113(11): 1949-1954 . 18 . Dowthwaite SA, Franklin JH, Palma DA, Fung K, Yoo J, Nichols AC. The role of transoral robotic surgery in the management of oropharyngeal cancer: a review of the literature. ISRN Oncol . 2012; 2012:945162 . 19 . Calais G, Alfonsi M, Bardet E, et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst . 1999;91(24):2081-2086 .

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