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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-
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
Table 1. Characteristics of the Study Population
Characteristic
No. (%)
Patient
Male sex
26 (76)
Age, mean (SD), y
59 (8)
Race
White
32 (94)
African American
2 (6)
History
Smoking
24 (70)
Alcohol use
a
20 (59)
Disease
Primary site
Tonsil
16 (47)
Tongue base
15 (44)
Soft palate
2 (6)
Pharyngeal wall
1 (3)
Extracapsular spread
Yes
4 (12)
No
15 (44)
Not evaluated
15 (44)
T category
T1
20 (59)
T2
13 (38)
T3
1 (3)
N category
N0
13 (38)
N1
16 (47)
N2a
3 (9)
N2b
2 (6)
p16 Status
Positive
25 (74)
Negative
8 (24)
Not evaluated
1 (3)
Perineural invasion
4 (12)
Positive margins
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.
Figure 1. Trends in 3 Global Quality-of-Life (QOL) Scale Scores
Across 24 Months
0
100
80
Mean QOL Score
60
40
20
No. of patients
1
12
24
Postoperative Time, mo
6
8
8
9
12
HR QOL compared
with 1 mo before
diagnosis
Overall QOL
HR QOL in past 7 d
a
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.
Robotic Surgery Alone in Oropharyngeal Cancer
Original Investigation
Research
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