title: Short-term postoperative distress associated with open vs. transoral robotic surgery (TORS) in patients with T1-T2 carcinomas of the tongue base and supraglottis.
abstract: BACKGROUND
  This study compared the adverse effects of open surgery (OS) including lateral pharyngotomy and supraglottic laryngectomy vs. transoral robotic surgery (TORS) in the treatment of stage T1 and T2 carcinomas of the tongue base and supraglottis.
  
  
  METHODS
  A retrospective study involving a 49 (13 female and 36 male) patients with untreated T1 or T2 carcinomas. Twenty two were operated on using TORS and 27 underwent conventional OS. The indicators for comparison were: total blood loss during surgery, post-operative pain measured with the Visual Analog Scale (VAS); global, emotional and physical post-operational states assessed with the standardized M.D. Anderson Dysphagia Inventory (MDADI) and psychosocial distress (PD) questionnaire. Apart from blood loss, subjective symptoms were evaluated 1 and 6 weeks and 6 months after surgery. The differences in indicators between groups were analyzed using Fisher's Least Significant Difference (LSD) test at the 5% significance level.
  
  
  RESULTS
  Mean general OS and TORS associated blood loss were 405 and 29 ml, respectively. The mean MDADI score in TORS vs. OS patients one week, six weeks and six months postoperatively was 60.01 vs. 44.93, 91.01 vs. 62.19 and 94.18 vs. 93.56. The mean VAS score in the TORS vs. OS group at the same time intervals were 5.09 vs. 5.56, 2.09 vs. 3.11 and 1.27 vs. 1.33. All differences between TORS and OS were statistically significant with the exception of 6 month values for particular scores. The mean PD score in TORS vs. OS patients in one week, six weeks and 6 months was 26.82 vs. 25.11, 39.95 vs. 29.22 and 44.73 vs. 44.52. Only the six week distinctions were significant. The both methods were comparable in terms of the risk of locoregional tumour recurrence.
  
  
  CONCLUSIONS
  The study confirmed the assumption of the TORS as a minimally invasive procedure significantly reducing the intraoperative blood loss, pain, swallowing and psychosocial distress as late as 6 weeks postoperatively in patients with early staged carcinomas of the tongue base and supraglottis.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery Department, Masaryk Hospital in Usti nad Labem and Department of Education, Faculty of Education, J. E. Purkyne University in Usti nad Labem, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Slama
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Slouka
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Slipka
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery Department, Masaryk Hospital in Usti nad Labem and Department of Education, Faculty of Education, J. E. Purkyne University in Usti nad Labem, Czech Republic.
authors.forename: Slavomil
authors.initials: S
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004825:Epiglottis / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010614:Pharynx / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D013315:Stress, Psychological / Q000209:etiology*; D014062:Tongue Neoplasms / Q000601:surgery*
keywords: MDADI; VAS; blood loss; carcinoma of tongue base and supraglottis; open surgery; psychosocial distress; transoral robotic surgery