title: Patient-perceived and objective functional outcomes following transoral robotic surgery for early oropharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate changes in patient-perceived swallowing function over time following transoral robotic surgery (TORS) for primary T1 and T2 oropharyngeal squamous cell carcinomas.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Forty-two patients with T1 or T2 oropharyngeal squamous cell carcinomas.
  
  
  METHODS
  TORS-assisted resection of indicated tumors.
  
  
  METHODS
  Changes in patient-perceived swallowing function over time (using the M. D. Anderson Dysphagia Inventory) and gastrostomy tube dependence.
  
  
  RESULTS
  Between March 19, 2007, and April 21, 2010, forty-two patients with primary T1 or T2 oropharyngeal squamous cell carcinomas underwent TORS-assisted resection. Most (76% [32 of 42]) patients had stage III disease; 93% (39 of 42) of patients underwent staged neck dissection. The median postoperative follow-up time was 17 months (range, 4-40 months). There were no complications or tumor recurrences. Postoperative chemotherapy use predicted gastrostomy tube retention for longer than 3 months (P = .01). Immediate mean postoperative M. D. Anderson Dysphagia Inventory scores in each assessed domain (global, emotional, physical, and functional) decreased compared with preoperative baseline scores; however, ongoing improvement in all domains was observed over time. Nodal status (P = .049), follow-up time of less than 12 months (P = .03), and preoperative physical scores of less than 100 (P = .01) predicted poorer physical M. D. Anderson Dysphagia Inventory outcomes. Positive pathological margins predicted poorer functional scores (P = .03).
  
  
  CONCLUSIONS
  After TORS-assisted resection of T1 and T2 oropharyngeal squamous cell carcinomas, approximately one-third of patients will experience a sustained decrease in perceived swallowing function. However, ongoing improvement of swallowing function over time is likely even after 12 months. Patients receiving adjuvant chemotherapy after TORS should be counseled about the possibility of prolonged gastrostomy tube dependence.
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Alabama at Birmingham, 1530 Third Ave. S, Birmingham, AL 35294-0012, USA. entdoc@uab.edu
authors: Catherine F
authors: CF
authors: Sinclair
authors: Nancy L
authors: NL
authors: McColloch
authors: William R
authors: WR
authors: Carroll
authors: Eben L
authors: EL
authors: Rosenthal
authors: Reneé A
authors: RA
authors: Desmond
authors: J Scott
authors: JS
authors: Magnuson
mesh_terms: D003679:Deglutition / Q000502:physiology*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures / Q000379:methods; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome