title: Oncologic Outcomes After Transoral Robotic Surgery: A Multi-institutional Study.
abstract: OBJECTIVE
  Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer.
  
  
  OBJECTIVE
  To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality.
  
  
  METHODS
  A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions.
  
  
  METHODS
  Select patients received radiation therapy and/or chemotherapy before or after TORS.
  
  
  METHODS
  Locoregional control, disease-specific survival, and overall survival were calculated. We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors.
  
  
  RESULTS
  Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8% (95% CI, 87.6%-94.7%), disease-specific survival 94.5% (95% CI, 90.6%-96.8%), and overall survival 91% (95% CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P = .05) and for patients with tumors arising in tonsil (P = .01). Smoking was associated with worse overall all-cause mortality (P = .01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis.
  
  
  CONCLUSIONS
  This large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.affiliation: Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
authors.forename: Ryan
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric
authors.initials: E
authors.lastname: Moore
authors.affiliation: Catholic University of Louvain at Mont-Godinne, Yvoir, Belgium.
authors.forename: Georges
authors.initials: G
authors.lastname: Lawson
authors.affiliation: Catholic University of Louvain at Mont-Godinne, Yvoir, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Remacle
authors.affiliation: Department of Surgery, Head and Neck Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.affiliation: New York Head and Neck Institute, North Shore Health System, New York, New York.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Marita S
authors.initials: MS
authors.lastname: Teng
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham.
authors.forename: Hilliary
authors.initials: H
authors.lastname: White
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania.
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
authors.forename: Krista
authors.initials: K
authors.lastname: Kiyosaki
authors.affiliation: Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Damrose
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kupferman
authors.affiliation: Severance Hospital, Yonsei University School of Medicine, Seoul, Korea.
authors.forename: Yoon Woo
authors.initials: YW
authors.lastname: Koh
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.affiliation: Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures; D015996:Survival Rate; D016896:Treatment Outcome