Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery

Abstract

Objective: Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.

Methods: We retrospectively investigated patients with early glottic carcinoma (Tis, T1, T2) who underwent TORS cordectomy in a tertiary hospital between January 2010 and June 2018.

Results: Forty-eight patients were enrolled in the study. Mean follow-up time was 65.6±16.6months. Only one patient died and overall survival rate was found 97.9%. Local recurrence occurred in five patients and disease free survival rate was found 89.6%. Anterior commissure involvement was occurred in 6 (12.5%) patients and local recurrence was seen two of them (33.3%). Synechia complication was occurred in 8 (16.7%) patients and local recurrence was seen three of them (36.7%). Although local recurrence rate was high in both anterior commissure involvement and synechia, only synechia reached to statistical significance for local recurrence (p: 0.027). The recurrences of four patients were treated with radiation therapy (RT) and the remaining one patient underwent total laryngectomy. Laryngeal preservation rate was found 97.9%.

Conclusion: Our investigation of the oncological outcomes of TORS on early-stage glottic carcinoma revealed that TORS has similar results when compared with transoral laser microsurgery and RT in terms of recurrence, laryngeal preservation and survival rates. Synechia is also a cautionary complication for recurrence and must be followed closely. We expect that TORS usage will be wider if robotic technology works on innovative developments oriented to glottic area.

Keywords: Early; Glottic carcinoma; Oncological outcome; TORS.