title: Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes.
abstract: OBJECTIVE
  Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially.
  
  
  OBJECTIVE
  To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC.
  
  
  METHODS
  This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center.
  
  
  METHODS
  Primary surgical resection via TORS and neck dissection as indicated.
  
  
  METHODS
  Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected.
  
  
  RESULTS
  Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both).
  
  
  CONCLUSIONS
  Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus2Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dziegielewski
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
authors.forename: Kasim
authors.initials: K
authors.lastname: Durmus
authors.forename: Matthew
authors.initials: M
authors.lastname: Old
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Kiran
authors.initials: K
authors.lastname: Kakarala
authors.forename: Anna
authors.initials: A
authors.lastname: Marcinow
authors.forename: Enver
authors.initials: E
authors.lastname: Ozer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003679:Deglutition / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012371:Robotics / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology