Transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma
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Squamous cell carcinoma (SCC) of the oropharynx affects nearly 50,000 individuals in the United States each year, and, with the rising incidence of the human papillomavirus (HPV), the number of patients diagnosed with SCC is expected to continue to grow (American Cancer Society 2018; Coughlan and Frick 2012). Oropharyngeal squamous cell carcinoma (OPSCC) has traditionally been treated with wide surgical extirpation often involving removal of portions of the oral cavity, pharynx, and jaw; this kind of surgery can be disfiguring and has been associated with significant post-operative complications (Brickman and Gross 2014). In the late 20th century, clinicians began favoring the use of chemoradiation therapy instead of surgery in an effort to spare patients the morbidity associated with surgical techniques at the time (Mercante et al. 2015). While chemoradiation offers excellent survival for patients with SCC, this therapeutic strategy has been observed to have its own debilitating post-treatment side effects (Hamilton and Paleri 2017). An important advancement in the management of OPSCC occurred about 20 years ago with the advent of transoral robotic surgery (TORS), a surgical technique that uses a robotic system to operate through the natural opening of the mouth. Proponents of TORS suggest that the technology improves on conventional surgery and may provide patients with functional outcomes superior to those seen with chemoradiation with no sacrifice in survival (Yeh et al. 2015; Hay et al. 2017). This review investigates the validity of the concept that TORS has significant advantages in the modern-day treatment of OPSCC. This report includes three components. First, the TORS technology, its advantages, and its drawbacks are explained. Second, relevant medical literature is reviewed to provide an understanding of the rationale for utilizing TORS in the treatment of OPSCC. Review and analysis of published reports show that TORS can provide patients with excellent post-operative function, good quality of life, and acceptable survival rates. Notable exceptions include patients with advanced disease. Third, this review discusses future studies that will better inform caregivers about the utility of TORS in the treatment of OPSCC. TORS is a relatively new technology that seems to offer the possibility of helping to improve the lives of patients with OPSCC.