Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes

Abstract

Importance: Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially.

Objective: To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC.

Design, participants, and setting: This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center.

Interventions: Primary surgical resection via TORS and neck dissection as indicated.

Main outcomes and measures: Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected.

Results: Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both).

Conclusions and relevance: Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.

Figure 1

Perioperative HNCI HRQOL scores by QOL domain. Abbreviations: HNCI, Head and Neck Cancer Inventory; HRQOL, Health Related Quality of Life; QOL, Quality of Life; wks, weeks; mos, months.

Figure 1

Perioperative HNCI HRQOL scores by QOL domain. Abbreviations: HNCI, Head and Neck Cancer Inventory; HRQOL, Health Related Quality of Life; QOL, Quality of Life; wks, weeks; mos, months.