title: Transoral robotic surgery: implementation as a tool in head and neck surgery - a single-centre Australian experience.
abstract: Transoral robotic surgery (TORS) is now a well-validated technique for resection of head and neck cancers. Benefits include reduced patient morbidity, swallowing preservation and rationalization of adjuvant therapies.
  
  
  
  This was a single-centre, retrospective review of 35 patients who underwent TORS of oro-, retro- and parapharyngeal tumours between March 2014 and August 2015. Outcome measures included resection margins, swallowing function and impact on post-operative radiotherapy.
  
  
  
  Median age was 63.7 years and the number of male patients was 22 (62.9%). Tongue base was the most common site (51.4%), followed by tonsil (25.7%). Nine patients (25.7%) had previous radiotherapy. A total of 24 patients had squamous cell carcinoma and the clear margin rate for primary TORS was 93.3%. Median hospital stay was 5.5 days, longer for previously irradiated patients (9 days). Median nasogastric tube dependence was 3.5 days. Four patients (11.4%) received a gastrostomy and two patients remained dependent on the tube at the time of last review. There were two major complications (5.7%): bleeding requiring return to theatre (1) and pulmonary embolism (1). Post-operative radiotherapy was either avoided or reduced in 22 patients (81.5%).
  
  
  
  TORS is a safe and effective tool, providing surgical access to oropharyngeal and other difficult to access areas. Patient selection and a multidisciplinary approach are essential to ensure adequate margins can be achieved and therefore to reduce adjuvant therapies.
authors.affiliation: Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Nir
authors.initials: N
authors.lastname: Hirshoren
authors.affiliation: Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Olivia
authors.initials: O
authors.lastname: Ruskin
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Tsien
authors.initials: T
authors.lastname: Fua
authors.affiliation: Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kleid
authors.affiliation: Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Magarey
authors.affiliation: Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Dixon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009055:Mouth; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck / Q000601:surgery*; D016896:Treatment Outcome
keywords: head and neck; salvage; squamous cell carcinoma; transoral robotic surgery