Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 10;150(11):1002-1011.
doi: 10.1001/jamaoto.2024.3371. Online ahead of print.

Transoral Laser or Robotic Surgery Outcomes for Oropharyngeal Carcinoma: Secondary Analysis of the PATHOS Randomized Clinical Trial

James T O'Hara  1   2 , Christopher N Hurt  3   4 , Kate Ingarfield  4 , Joanne M Patterson  5 , Katherine Hutcheson  6   7 , Joanna E Canham  4 , Lisette S Nixon  4 , Christie D Heiberg  4 , Sean Johson  4 , Mererid Evans  8 , Terry M Jones  5
Affiliations

Transoral Laser or Robotic Surgery Outcomes for Oropharyngeal Carcinoma: Secondary Analysis of the PATHOS Randomized Clinical Trial

James T O'Hara et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Background: Transoral robotic surgery (TORS) or transoral laser microsurgery (TLM) offer excellent oncological outcomes for oropharyngeal squamous cell carcinoma caused by human papillomavirus (HPV) infection. TORS may offer greater margin clearance around tumors than TLM.

Objective: To determine whether the differing energy sources used and surgical technique of TORS or TLM is associated with postoperative early swallowing function, feeding tube use, and specific factors related to quality of life.

Design, setting, and participants: This prespecified cohort study was performed within the Postoperative Adjuvant Treatment for HPV-Positive Tumours (PATHOS) randomized clinical trial at 40 centers in the UK, Germany, France, the US, and Australia between November 1, 2015, and August 31, 2023. PATHOS trial participants with HPV-positive oropharyngeal carcinoma of stages T1 to T3 and N0 to N2b M0 (TNM7) who underwent TLM or TORS were eligible. Of 989 consecutively recruited patients on the PATHOS trial, 508 were eligible for this substudy.

Exposures: The exposure of interest was TORS or TLM.

Main outcomes and measures: Preplanned outcome measures included nasogastric tube insertion rates within 4 weeks after surgery, length of in-hospital stay following surgery, specific scales from the MD Anderson Dysphagia Inventory (MDADI), 35-item European Organization for Research and Treatment of Cancer Head and Neck Questionnaire (H&N35), and 30-item Quality of Life Questionnaire (QLQ C30), water swallow test results, and videofluoroscopy scores.

Results: Of the 508 patients included in the analysis (390 [76.8%] male; median age, 58.3 [IQR, 52.8-63.6] years), 195 had TLM and 313 had TORS. Nasogastric tube insertion rates were higher after TORS than TLM (85 of 189 [45.0%] vs 10 of 126 [7.9%]; adjusted odds ratio [OR], 4.41 [95% CI, 1.01-19.32]). Mean scores favored TLM with small effect sizes in all MDADI domains and the H&N35 swallowing item at 4 weeks after surgery; between-group difference for the MDADI composite score was -4.89 (95% CI, -8.27 to -1.50); for the MDADI physical functioning score, -6.37 (95% CI, -10.15 to -2.59); for the MDADI global score, -10.02 (95% CI, -16.50 to -3.54); and for H&N35 swallowing score, 7.24 (95% CI, 2.17-12.30). No other measures showed evidence of clinically meaningful differences.

Conclusions and relevance: In this cohort study, functional outcomes were moderately less impaired 4 weeks following TLM compared with TORS. Once the longer-term outcomes for these patients are known, these findings could aid the design and use of future head and neck-specific surgical robots.

Trial registration: ClinicalTrials.gov Identifier: NCT02215265.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Mr Hurt reported receiving personal fees from AstraZeneca and Daiichi Sankyo for faculty membership and presentation at a Clinical Trial Investigator Meeting in December 2023 outside the submitted work. Dr Hutcheson reported grant funding from ATOS PATH and MD Anderson Head and Neck Collaborative, ATOS Medical, during the conduct of the study and grant funding from PRO-ACTIVE outside the submitted work. Dr Jones reported personal fees from Chair Pharmaceuticals, Informatica, and GSK outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Postoperative Adjuvant Treatment for Human Papillomavirus (HPV)–Positive Tumours (PATHOS) Randomized Clinical Trial Schema
HN&35 indicates 35-item European Organization for Research and Treatment of Cancer Head and Neck Questionnaire; MDADI, MD Anderson Dysphagia Inventory; QLQ CL30, 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; and VFSS, videofluoroscopic swallow study. Number signs represent fractions of radiotherapy.
Figure 2.
Figure 2.. Flow Diagram for Substudy Analysis
H&N35 indicates 35-item European Organization for Research and Treatment of Cancer Head and Neck Questionnaire; MDADI, MD Anderson Dysphagia Inventory; PATHOS, Postoperative Adjuvant Treatment for HPV (Human Papillomavirus)-Positive Tumours; QLQ CL30, 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; TLM, transoral laser microsurgery; TORS, transoral robotic surgery; and VFSS, videofluoroscopic swallow study.
See this image and copyright information in PMC

References

    1. Lechner M, Liu J, Masterson L, Fenton TR. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol. 2022;19(5):306-327. doi:10.1038/s41571-022-00603-7 - DOI - PMC - PubMed
    1. Dalton CL, Milinis K, Houghton D, et al. . Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: equitable survival and enhanced function compared with contemporary standards of care. Eur J Surg Oncol. 2020;46(11):2042-2049. doi:10.1016/j.ejso.2020.06.045 - DOI - PubMed
    1. O’Hara J, Warner L, Fox H, et al. . Primary transoral robotic surgery ± adjuvant therapy for oropharyngeal squamous cell carcinoma—a large observational single-centre series from the United Kingdom. Clin Otolaryngol. 2021;46(5):1005-1012. doi:10.1111/coa.13769 - DOI - PubMed
    1. Steiner W. Experience in endoscopic laser surgery of malignant tumours of the upper aero-digestive tract. Adv Otorhinolaryngol. 1988;39:135-144. doi:10.1159/000415662 - DOI - PubMed
    1. Weinstein GS, O’Malley BW Jr, Snyder W, Sherman E, Quon H. Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg. 2007;133(12):1220-1226. doi:10.1001/archotol.133.12.1220 - DOI - PubMed

Associated data