Introducción de la cirugía robótica transoral en España2011-2021. Resultados oncológicos y funcionales de una serie multicéntrica de cáncer de orofaringe

Résumé

Introduction. Transoral robotic surgery (TORS) has changed the way we approach the treatment of oropharyngeal cancer. It allows a minimally invasive surgical approach, reducing the morbidity of the procedures and improving the functional outcomes compared to its alternatives (open surgery and primary non-surgical treatments with radiotherapy or radiochemotherapy). This has had a particular impact on a growing group of patients with tumors related to the human papillomavirus (HPV), younger and with a better prognosis than patients with classic tumors etiologically related to toxic habits (tobacco and alcohol). Objectives. To evaluate the feasibility of establishing a TORS program in the Spanish health system through an analysis of safety and effectiveness. Patients and methods. We designed a prospective multicenter study on a cohort without a control group of patients with oropharyngeal carcinoma treated primarily by TORS. Epidemiological and clinical data from the programs of 4 hospitals were collected between July 2013 and December 2021. Data regarding patient safety and functional outcomes, as well as oncologic outcomes based on recurrences and survival were evaluated. Results. 142 patients were included, 25.4% women, with a mean age of 62.9 years. 37.6% had a squamous cell carcinoma induced by HPV. Approximately one third of the cases (36.2%) were classified as advanced stage (Ill/lV), although this did not apply to any of the HPV+ cases when they were reclassified from the 7th to the 8th edition of the TNM classification. In almost half of the patients (47.5%) an exclusively surgical treatment was performed. Almost half of the patients (47.2%) were managed without feeding tubes in the postoperative period (the median use of the nasogastric tube in those who did use it was 1 week). The mean stay was 9.3 days (SD 8.8). In the long term, 92.6% of the patients had normal or almost normal swallowing. Specific survival at 2 and 5 years was 90.5% and 86.7%, respectively, for HPV+ tumors, and 81.0% and 72.5%, respectively, for HPV-. Conclusion. Transoral robotic surgery has been safe and effective in our centers for the treatment of oropharyngeal cancer and is associated with excellent functional and oncological results.