Implications of transoral robotic surgery on the field of otolaryngology: contemporary management of oropharyngeal cancers
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The incidence and prevalence of cancers of the oropharynx has been on the rise over recent years, with approximately 13,000 new cases diagnosed each year in the United States. Increased incidence has been linked to increased alcohol consumption, tobacco use, and the human papilloma virus, and stresses the importance for the development of modern treatments. The majority of oral cancers are squamous cell carcinomas, originating in the mucosal tissue layer and metastasizing throughout the neck to surrounding lymph nodes and organs. Due to the difficulty in the detection of oropharyngeal cancers, they are often detected in late stage and must be removed surgically to maximize survival. Treatment of head and neck cancers falls under the responsibility of otolaryngologists, who utilize a wide variety of surgical and non-surgical procedures to minimize morbidity and maximize the patient's chances of survival while maintaining high quality of life. The classic approach to the treatment of head and neck cancers has been a combination of neck dissection, removal of lymph nodes, and radiation therapy to obliterate the disease in its entirety. Saving the life of the patient often results in many complications as a result of the invasive and aggressive treatments. In order to maximize the removal of the cancer, collateral damage to surrounding nerves, muscles, and other essential tissues often occurs with dissection of the neck. This radical approach often leaves little regard for the future quality of life of the patient, and alternatives are being sought to address these needs. Along with other surgical fields, otolaryngology is moving toward a minimally invasive approach in the treatment of oropharyngeal cancers. With the advent of modern technology and miniaturization of instruments, minimally invasive procedures such as endoscopic surgery, laser surgery, and concentrated radio- and chemotherapeutics have allowed otolaryngologists a greater range of possible treatments for their patients. In the recent evolution of surgical treatment, robots have been developed and adapted to assist surgeons in performing difficult procedures which are otherwise not possible. Utilizing robotic arms under the control of a trained surgeon, transoral robotic surgery allows for the removal of diseased tissue via the oral cavity. This recent procedural development allows surgeons to remove cancerous lesions from the head and neck without the need for a large external incisions. This approach minimizes tissue trauma, leaving unrelated organs and tissues of the neck intact. By reducing damage to surrounding structures, transoral robotic surgery improves the prognosis of, and speeds post-surgical recovery of the patient. Transoral robotic surgery is quickly gaining traction as an acceptable alternative to open surgeries in the management of head and neck cancers, allowing for preservation of structure and function. Although promising, many variables must be considered to determine whether it is in fact the most appropriate treatment. Factors such as quality of life, the ability to swallow and speak, recovery time, comorbidity, and survival must all be taken into consideration. While transoral robotic surgery presents many benefits to the surgical team and patient, there are inevitably some drawbacks and limitations to this new and promising technology. Only recently developed and approved for the minimally invasive treatment of head and neck cancers, it presents novel and exciting possibilities to the field of otolaryngology. By analyzing the literature on surgical treatment of oropharyngeal cancers over the past twenty years, I weigh the costs and benefits of transoral robotic surgery against traditional approaches to determine what role this new procedure plays in the contemporary management of oropharyngeal cancer.
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