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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
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-
Table 3. Symptom-Specific QOL Domains
QOL Domain
Postsurgery QOL Score, Median (IQR)
a
1 Month
6 Months
12 Months
24 Months
Patients, No.
8
12
8
9
Activity
63 (50-88)
75 (50-100)
100 (75-100)
100 (75-100)
P
value
.43
.10
.03
b
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)
100 (75-100)
100 (75-100)
P
value
.35
.67
>.99
Chewing
50 (50-100)
100 (50-100)
100 (100-100)
100 (100-100)
P
value
.40
<.05
b
.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)
P
value
<.01
b
.01
b
.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)
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)
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)
100 (70-100)
100 (70-100)
P
value
.05
b
.07
.05
b
Taste
100 (50-100)
70 (70-85)
100 (70-100)
100 (70-100)
P
value
.43
.86
>.99
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.
Robotic Surgery Alone in Oropharyngeal Cancer
Original Investigation
Research
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