title: Up-front and Salvage Transoral Robotic Surgery for Head and Neck Cancer: A Belgian Multicenter Retrospective Case Series.
abstract: OBJECTIVE
  We analyzed the functional and oncologic outcomes of primary and salvage transoral robotic surgery (TORS) procedures, performed in three Belgian institutions with a similar philosophy.
  
  
  METHODS
  A total of 86 patients who underwent TORS between 24-12-2009 and 25-09-2015 were retrospectively reviewed. Descriptive statistics, overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS; Kaplan-Meier), and the variation of these outcomes according to whether patients had primary or salvage TORS were evaluated (univariate log-rank analysis).
  
  
  RESULTS
  Of 86 patients, 56 (65.1%) underwent TORS as a primary treatment and 30 (34.9%) as a salvage procedure for recurrent or second primary cancer. Tumor location was mainly oropharynx (N= 63; 73.3%) followed by supraglottic larynx (N= 11; 12.8%), hypopharynx (N= 11; 12.8%), and glottic larynx (N= 1; 1.2%). In the up-front TORS group, most tumors were classified as cT1 (N= 23; 41.1%)/pT1 (N= 24; 42.9%) or cT2 (N= 27; 48.2%)/pT2 (N= 27; 48.2%) and cN0 (N= 18; 32.1%), cN1 (N= 13; 23.2%), or cN2 (N= 25; 44.6%). In the salvage TORS group, most tumors were cT1-rT1 (N= 18; 60.0%)/pT1-rpT1 (N= 18; 60.0%) or cT2-rT2 (N= 12; 40.0%)/pT2-rpT2 (N= 7; 23.3%) and cN0 (N= 25; 83.3%). Neck dissection was performed in 87.5% of primary cases and 30.0% of salvage cases. In the up-front TORS group, patients were postoperatively submitted to follow-up (N= 13; 23.2%) or received adjuvant radiotherapy, either as single modality (N= 26; 46.4%) or with concomitant cisplatin (N= 15; 26.8%). On the other hand, most salvage TORS patients did not receive any adjuvant therapy (N= 19; 63.3%). Mean and median follow-up was 23.1 and 21.2 months, respectively. Functional results were excellent (no definitive tracheostomy, long-term tube feeding in 1.8% of primary cases, and 20% of salvage cases). In the up-front TORS group, estimated 2-year OS was 88.5% (SE = 5.0%), 2-year DSS was 91.8% (SE = 4.6%) and 2-year DFS was 86.1% (SE = 5.3%). In the salvage TORS group, estimated 2-year OS was 73.5% (SE = 10.9%), 2-year DSS was 93.3% (SE = 6.4%), and 2-year DFS was 75.8% (SE = 9.7%). Comparing outcome of primarily treated patients to salvage patients, a non-statistically significant trend toward better OS (p= 0.262) and DFS (p= 0.139) was observed.
  
  
  CONCLUSIONS
  This retrospective study confirms favorable oncologic and functional outcomes of TORS for selected head and neck malignancies, both in the primary and in the salvage setting.
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Meulemans
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vanclooster
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan , Bruges , Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Vauterin
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: D'heygere
authors.affiliation: Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium.
authors.forename: Sandra
authors.initials: S
authors.lastname: Nuyts
authors.affiliation: Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Clement
authors.affiliation: Department of Radiology, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Hermans
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Delaere
authors.affiliation: Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vander Poorten
keywords: oropharyngeal cancer; salvage surgery; squamous cell carcinoma; supraglottic cancer; transoral robotic surgery