2017 Section 7 Green Book

178 / 220

Copyright 2015 American Medical Association. All rights reserved.
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-
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.
ARTICLE INFORMATION
Submitted for Publication: October 2, 2014; final
revision received January 27, 2015; accepted
February 15, 2015.
Published Online: April 2, 2015.
doi
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
2. Logan RM. Advances in understanding of
toxicities of treatment for head and neck cancer.
3. Moore EJ, Olsen SM, Laborde RR, et al.
Long-term functional and oncologic results of
transoral robotic surgery for oropharyngeal
squamous cell carcinoma
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
5. Weinstein GS, Quon H, Newman HJ, et al.
Transoral robotic surgery alone for oropharyngeal
cancer: an analysis of local control
6. Moore EJ, Hinni ML. Transoral laser
microsurgery and robotic-assisted surgery for
oropharynx cancer including human
papillomavirus-related cancer
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
8. Hurtuk AM, Marcinow A, Agrawal A, Old M,
Teknos TN, Ozer E. Quality-of-life outcomes in
transoral robotic surgery
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
10. Dziegielewski PT, Teknos TN, Durmus K, et al.
Transoral robotic surgery for oropharyngeal cancer:
long-term quality of life and functional outcomes.
11. Durmus K, Patwa HS, Gokozan HN, et al.
Functional and quality-of-life outcomes of transoral
robotic surgery for carcinoma of unknown primary.
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.
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
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
15. Logemann JA, Pauloski BR, Rademaker AW,
et al. Swallowing disorders in the first year after
radiation and chemoradiation
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
17. Tschudi D, Stoeckli S, Schmid S. Quality of life
after different treatment modalities for carcinoma
of the oropharynx
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
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
Research Original Investigation Robotic Surgery Alone in Oropharyngeal Cancer
JAMA Otolaryngology–Head & Neck Surgery June 2015 Volume 141, Number 6 (Reprinted)
158