Transoral Robotic Surgery Consensus Guidelines Head and Neck Surgery
Abstract :
[en] Background: Substantial heterogeneity in practice exists across centers regarding the indications and perioperative care for patients undergoing transoral robotic surgery (TORS) for head and neck cancer. This consensus paper aims to propose a European surgical practice guideline in this setting. Methods: Twenty-two experts from European and International scientific societies participated in a modified Delphi process for rating and validating statements about indications, contraindications, surgical outcomes, and pre-and postoperative care associated with TORS for head and neck cancer care. Consensus was deemed to have been achieved when two-thirds of experts agreed or strongly agreed with the statement; those with fewer than one-third agreement were improved and resubmitted for voting until final validation or rejection. Results: Of the initial 41 statements, 38 reached consensus after three voting rounds. Statements propose recommendations for the preoperative assessment (n = 7), indications and contraindications for TORS in oropharyngeal, laryngeal, and hypopharyngeal primaries (n = 10), surgical outcomes to be reported (n = 7), postoperative care (n = 8), and clinical research (n = 6). TORS is appropriate for small, accessible oropharyngeal and supraglottic tumors with favorable exposure. The contraindications set out in detail for oropharyngeal, laryngeal and hypopharyngeal lesions will assist in decision-making, especially when presented with a controversial clinical scenario. Standardized reporting of surgical, functional, and oncological outcomes, including swallowing, voice quality, and survival rates, is essential for evidence-based practice. TORS represents a promising avenue for therapeutic de-escalation in HPV-positive oropharyngeal cancers. Conclusion: The European TORS surgical consensus provides clinical recommendations for the indications, contraindications, surgical and perioperative care for TORS management of head and neck malignancies.
Disciplines :
Otolaryngology
Author, co-author :
Lechien, Jérôme; Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium ; Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, Mons, Belgium ; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France ; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium ; Phonetics and Phonology Laboratory (CNRS-UMR 7018, Université Sorbonne Nouvelle, Paris, France
Paleri, Vinidh; Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK ; The Institute of Cancer Research, London, UK
Baudouin, Robin; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
Brunet, Aina; Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitari Bellvitge, Universitat de Barcelona, Barcelona, Spain ; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
Chiesa-Estomba, Carlos; Department of Head and Neck Surgery, Hospital Universitario Donostia, Biodonostia Research Institute, San Sebastián, Spain ; International Federations of Oto-rhino-laryngological Societies (YO IFOS), Head & Neck Study Group of Young-Otolaryngologists, Paris, France
Crosetti, Erika; ENT Clinic -Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
De Vito, Andrea; ENT Unit, Morgagni Pierantoni Hospital, Forli, Italy
Cammaroto, Giovanni; International Federations of Oto-rhino-laryngological Societies (YO IFOS), Head & Neck Study Group of Young-Otolaryngologists, Paris, France ; ENT Unit, Morgagni Pierantoni Hospital, Forli, Italy
De Virgilio, Armando; Department Organs of Sense, Sapienza' University of Rome, Roma, Italy
Fakhry, Nicolas; Department of Oto-Rhino-Laryngology -Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, Marseille, France
Golusinski, Wojciech; Department of Head and Neck Surgery, University of Medical Sciences, Poznan, Poland ; The Greater Poland Cancer Centre, Poznan, Poland
Irjala, Heikki; Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
Leemans, C; Amsterdam UMC, Otolaryngology/Head and Neck Surgery, Vrije Universiteit Amsterdam, the Netherlands
Moriniere, Sylvain; Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Tours, Université Francois-Rabelais, Tours, France
Saibene, Alberto; International Federations of Oto-rhino-laryngological Societies (YO IFOS), Head & Neck Study Group of Young-Otolaryngologists, Paris, France ; Otolaryngology Department, Department of Health Sciences, Santi Paolo e Carlo Hospital, Universita' degli Studi di Milano, Milan, Italy
Sampieri, Claudio; Department of Medical Science (DIMES), University of Genoa, Genoa, Italy ; Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
Siddiq, Somiah; Head and Neck Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Poorten, Vincent; Otorhinolaryngology-Head and Neck Surgery, Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, Leuven, Belgium aa ; ab Otorhinolaryngology Department, KU Leuven, Leuven, Belgium ; ac Otorhinolaryngology-Head and Neck Surgery, Hospital Vall d'Hebron, Barcelona Campus Universitat Autònoma de Barcelona, Barcelona, Spain ; Department of Neuropsychiatry and Computational Medicine, CHU de Toulouse, Toulouse, France ad ; ae Department of Medicine and Surgery, University of Mons, Mons, Belgium ; Department of ORL-Head & Neck Surgery, Enna Kore University, Enna, Italy af ; Department of Otolaryngology-Head and Neck Surgery, CHEM ESCH, Luxembourg ag ; ah Otorhinolaryngology Department, CHUV, University of Lausanne, Lausanne, Switzerland ; Hospital Clínic, Barcelona, Spain
Viros, David
Ab, Porcuna
Vergez Ac, Sébastien
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Maniaci, Antonino; Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
Remacle, Marc
Simon, Christian
Hans, Stéphane; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France ; Phonetics and Phonology Laboratory (CNRS-UMR 7018, Université Sorbonne Nouvelle, Paris, France
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