[en] Transoral robotic surgery (TORS) allows minimally invasive surgical access to the oropharynx. Its benefits are well documented for squamous cell carcinomas, but not for salivary carcinomas. The aim of this study was to describe the French experience of TORS regarding salivary gland carcinomas of the base of tongue (BOT). This was a retrospective multicentric study with a national cohort. We included all patients treated surgically for a BOT salivary gland carcinoma from January 2009 to December 2018. Descriptive analyses were performed. Among the 50 patients included, radical excision was performed through an open approach (OA; n = 33) or using TORS (n = 17). T1-T2 tumors were more common in the TORS-group (76.4% vs 60.6%), and so were low-grade tumors (58.8% vs 38.7%). Surgical margins were <1mm in 46.7% of patients in the TORS-group and 52% of patients in the OA-group. After 51.7 months of follow-up, two patients (11.8%) presented with a local recurrence in the TORS-group, versus eight patients (24.2%) in the OA-group. The rate of tracheostomy was 41.2% in the TORS-group and 63.6% in the OA-group. The rate of gastrostomy was 11.8% in the TORS-group and 36.4% in the OA-group. TORS is an acceptable minimally invasive option for selected BOT salivary carcinomas. It may provide good functional and oncological outcomes in selected cases, despite a high rate of close margins.
Disciplines :
Otolaryngology
Author, co-author :
Poissonnet, Valentine; Otolaryngology, Head and Neck Surgery Department, University Cancer Institute Toulouse and Toulouse University Hospital, Larrey Hospital, 24 Chemin de Pouvourville, 31059, Cedex 9, Toulouse, France. valentine.poissonnet@gmail.com
Chabrillac, Emilien; Otolaryngology, Head and Neck Surgery Department, University Cancer Institute Toulouse and Toulouse University Hospital, Larrey Hospital, 24 Chemin de Pouvourville, 31059, Cedex 9, Toulouse, France
Segier, Bertille; Statistical Department, Institut Claudius Régaud, University Institute of Cancer, 1 Avenue Irène Joliot-Curie, 31100, Toulouse, France
Gorphe, Philippe; Head and Neck Oncology Department, Gustave-Roussy Institute, 114 Rue Edouard Vaillant, 94800, Villejuif, France
Wong, Stéphanie; Department of Radiation Therapy, AP-HM, Aix-Marseille University, 264 Rue Saint Pierre, 13385, Marseille, France
Garrel, Renaud; Otolaryngology, Head and Neck Surgery Department, University Hospital of Montpellier, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
Ferron, Christophe; Otolaryngology, Head and Neck Surgery Department, University Hospital of Nantes, 5 Allée de l'Ile Gloriette, 44000, Nantes, France
Kaci, Rachid; Pathology Department, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France
de Monès, Erwan; Department of Otorhinolaryngology and Head and Neck Surgery, Bordeaux University Hospital-CHU, F-33000 Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
Jegoux, Franck; Otolaryngology, Head and Neck Surgery Department, University Hospital of Rennes, 2 Rue Henri le Guilloux 35000, Rennes, France
Schultz, Philippe; Otolaryngology, Head and Neck Surgery Department, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France
Culié, Dorian; Otolaryngology, Head and Neck Surgery Department, Head and Neck University Institute, 31 Avenue de Valombrose, 06100, Nice, France
Baudouin, Robin; Otolaryngology, Head and Neck Surgery Department, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
Evrard, Diane; Otolaryngology, Head and Neck Surgery Department, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
Goffinet, Maxime ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'ORL, d'audiophonologie et de chir. cervico-faciale
Morinière, Sylvain; Otolaryngology, Head and Neck Surgery Department, University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France
Mirghani, Haitham; Otolaryngology, Head and Neck Surgery Department, George Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France
Righini, Christian; Otolaryngology, Head and Neck Surgery Department, University Hospital of Grenoble, Avenue des Maquis du Grésivaudan, 38700, La Tronche, France
Duflo, Suzy; Otolaryngology, Head and Neck Surgery Department, University Hospital of Point-à-Pitre, Route de Chauvel, Les Abymes, 97142, Guadeloupe, France
Marie, Jean Paul; Otolaryngology, Head and Neck Surgery Department, University Hospital of Rouen, 37 Boulevard Gambetta, 76000, Rouen, France
Guelfucci, Bruno; Otolaryngology, Head and Neck Surgery Department, Hospital of Toulon, 54 Rue Henri Sainte-Claire Deville, 83100, Toulon, France
Atallah, Sarah; Head and Neck Surgery Department, Tenon Hospital, APHP, Sorbonne University, 4 Rue de la Chine, 75020, Paris, France
Brenet, Esteban; Otolaryngology, Head and Neck Surgery Department, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
Bertolus, Chloé; Department of Oral and Maxillo-Facial Surgery, Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
Ceruse, Philippe; Otolaryngology, Head and Neck Surgery Department, University Hospital of Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Benite, France
Aubry, Karine; Otolaryngology, Head and Neck Surgery Department, University Hospital of Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
Dufour, Xavier; Otolaryngology, Head and Neck Surgery Department, University Hospital of Poitiers, 2 Rue de la Milétrie, 86000, Poitiers, France
Gallet, Patrice; Otolaryngology, Head and Neck Surgery Department, University Hospital of Nancy, 20 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
Bastit, Vianney; Otolaryngology, Head and Neck Surgery Department, University Hospital of Caen, Avenue de la Côte de Nacre CS 30001, 14000, Caen, France
Uro-Coste, Emmanuelle; Department of Anatomical Pathology, University Cancer Institute Toulouse, 1 avenue Irène Joliot-Curie, 31100, Toulouse, France
Vergez, Sébastien; Otolaryngology, Head and Neck Surgery Department, University Cancer Institute Toulouse and Toulouse University Hospital, Larrey Hospital, 24 Chemin de Pouvourville, 31059, Cedex 9, Toulouse, France
R. Devaraju R. Gantala H. Aitha S.G. Gotoor Mucoepidermoid carcinoma BMJ Case Rep 10.1136/BCR-2013-202776 25085946 4127757
M.J. Strick C. Kelly J.V. Soames N.R. McLean Malignant tumours of the minor salivary glands–a 20 year review Br J Plast Surg 57 624 631 1:STN:280:DC%2BD2cvmvFGltg%3D%3D 10.1016/J.BJPS.2004.04.017 15380695
A.N. Goel K.W. Badran A.P.G. Braun A.M. Garrett J.L. Long Minor salivary gland carcinoma of the oropharynx: a population-based analysis of 1426 patients Otolaryngol Head Neck Surg 158 287 294 10.1177/0194599817735309 28971745
R.H. Spiro Salivary neoplasms: overview of a 35-year experience with 2,807 patients Head Neck Surg 8 177 184 1:STN:280:DyaL28zgtlGrtQ%3D%3D 10.1002/HED.2890080309 3744850
N.G. Iyer L. Kim I.J. Nixon F. Palmer D. Kraus A.R. Shaha et al. Factors predicting outcome in malignant minor salivary gland tumors of the oropharynx Arch Otolaryngol Head Neck Surg 136 1240 1247 10.1001/ARCHOTO.2010.213 21173374
D.A. Silverman T.P. Carlson D. Khuntia R.T. Bergstrom J. Saxton R.M. Esclamado Role for postoperative radiation therapy in adenoid cystic carcinoma of the head and neck Laryngoscope 114 1194 1199 10.1097/00005537-200407000-00012 15235347
Vergez S, Fakhry N (2022) Réseau d’Expertise Français sur les Cancers ORL Rares Tumeurs malignes primitives des glandes salivaires. Recommandations Par Consensus Formalisé
P. Llerena K. Wang S.V. Puram P.J. Pipkorn R.S. Jackson C.A. Bollig National analysis of positive surgical margins in oropharyngeal salivary gland malignancies Am J Otolaryngol 10.1016/J.AMJOTO.2022.103527 35917657
M.H. Mella E. Chabrillac A. Dupret-Bories M. Mirallie S. Vergez Transoral robotic surgery for head and neck cancer: advances and residual knowledge gaps J Clin Med 10.3390/JCM12062303 36983308 10056198
G.S. Weinstein B.W. O’Malley J.S. Magnuson W.R. Carroll K.D. Olsen L. Daio et al. Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins Laryngoscope 122 1701 1707 10.1002/LARY.23294 22752997
G.D. Jefferson H. Frey Open versus robotic surgery for oropharyngeal cancer Otolaryngol Clin North Am 53 995 1003 10.1016/J.OTC.2020.07.010 32854946
I. Lawrence G.L.E. Goldblatt Salivary gland tumors of the tongue Cancer 10.1002/1097-0142(19870701)60:1<74::aid-cncr2820600113>3.0.co;2-b 2445461
National Comprehensive Cancer Network (2020) NCCN Clinical practice guidelines in oncology: head and neck cancer. Version 2
C.A. Bollig K. Wang P. Llerena S.V. Puram P.J. Pipkorn R.S. Jackson et al. National analysis of oropharyngeal salivary gland malignancies treated with transoral robotic surgery Otolaryngol Head Neck Surg 166 886 893 10.1177/01945998211031161 34311621
M. Berg A. Adnan A. Högmo H. Sjödin M. Gebre-Medhin G. Laurell et al. A national study of health-related quality of life in patients with cancer of the base of the tongue compared to the general population and to patients with tonsillar carcinoma Head Neck 43 3843 3856 10.1002/HED.26882 34558771
Matthew H (2021) Rigby BHHSMT. Reconstruction of the Oropharynx. vol 98
I. Sayin R. Fakhoury V.M.N. Prasad M. Remacle G. Lawson Transoral robotic surgery for base of tongue neoplasms B-ENT 24 45 50
F.C. Holsinger O.W.R. Laccourreye Surgical approaches to the oropharynx Oper Tech Otolaryngol Head Neck Surg 16 40 48 10.1016/j.otot.2005.02.001
H. White S. Ford B. Bush F.C. Holsinger E. Moore T. Ghanem et al. Salvage surgery for recurrent cancers of the oropharynx: comparing TORS with standard open surgical approaches JAMA Otolaryngol Head Neck Surg 139 773 778 10.1001/JAMAOTO.2013.3866 23949352
F. Hedayat K.K. Htwe L.V. Vassiliou P. Kyzas Morbidity related to the lip-split mandibulotomy approach: a systematic and narrative review Br J Oral Maxillofac Surg 60 430 436 10.1016/J.BJOMS.2021.09.019 35184915
S. Vergez B. Lallemant P. Ceruse S. Moriniere K. Aubry E. De Mones et al. Initial multi-institutional experience with transoral robotic surgery Otolaryngol Head Neck Surg 147 475 481 10.1177/0194599812443221 22473832
V. Razafindranaly B. Lallemant K. Aubry S. Moriniere S. Vergez M.E. De et al. Clinical outcomes with transoral robotic surgery for supraglottic squamous cell carcinoma: experience of a French evaluation cooperative subgroup of GETTEC Head Neck 38 Suppl 1 E1097 E1101 10.1002/HED.24163 26435046
R.O. Jamie J.P. Michael W. Binhuan D. Umamaheswar D.G. Neil E.V. Alec G.T. Luc B.G. Morris Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers Cancer 128 4 685 696 10.1002/cncr.33995
K.M. Van Abel M.H. Quick D.E. Graner C.M. Lohse D.L. Price K.A.R. Price et al. Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond Am J Otolaryngol Head Neck Med Surg 40 729 734 10.1016/j.amjoto.2019.07.003
H.S. Parhar C.M. Yver R.M. Brody Current indications for transoral robotic surgery in oropharyngeal cancer Otolaryngol Clin North Am 53 949 964 10.1016/J.OTC.2020.07.007 32912662
N.L. Villanueva J.R. De Almeida A.G. Sikora B.A. Miles E.M. Genden Transoral robotic surgery for the management of oropharyngeal minor salivary gland tumors Head Neck 36 28 33 10.1002/HED.23258 23554023
D.W. Schoppy M.E. Kupferman A.C. Hessel D.M. Bell E.M. Garland E.J. Damrose et al. Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx Cancers Head Neck 10.1186/S41199-017-0024-2 31093352 6460795
S.Y. Lee Y.M. Park H.K. Byeon E.C. Choi S.H. Kim Comparison of oncologic and functional outcomes after transoral robotic lateral oropharyngectomy versus conventional surgery for T1 to T3 tonsillar cancer Head Neck 36 1138 1145 10.1002/HED.23424 23836492
H.M. Matsuba J.R. Simpson M. Mauney S.E. Thawley Adenoid cystic salivary gland carcinoma: a clinicopathologic correlation Head Neck Surg 8 200 204 1:STN:280:DyaL28zgtlGqsg%3D%3D 10.1002/hed.2890080312 3017893
F. Liu Y. Chu Q. Zheng Y. Hu Y. Wang L. Qin et al. Major and minor perineural invasion in salivary gland cancer Front Oncol 10.3389/FONC.2024.1466196 40231264 11994929
V. Achim R.K. Bolognone A.D. Palmer D.J. Graville T.J. Light R. Li et al. Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer JAMA Otolaryngol Head Neck Surg 144 18 27 10.1001/JAMAOTO.2017.1790 29075740
J. Thariat F.R. Ferrand N. Fakhry C. Even S. Vergez E. Chabrillac et al. Radiotherapy for salivary gland cancer: REFCOR recommendations by the formal consensus method Eur Ann Otorhinolaryngol Head Neck Dis 10.1016/J.ANORL.2023.11.006 38061943
M.B. Hacioglu B. Erdogan M. Bardakcı E. Algın B. Gulbagcı I. Hacibekiroglu et al. Major and minor salivary gland cancers: a multicenter retrospective study Head Neck 45 1643 1653 10.1002/HED.27376 37084179
D.N. Kirke C. Chitguppi S.J. Rubin M.T. Truong S. Jalisi Adenoid cystic carcinoma of the base of tongue: a population-based study Am J Otolaryngol 38 279 284 10.1016/J.AMJOTO.2017.01.010 28173954
V.L.M. Vander Poorten A.J.M. Balm F.J.M. Hilgers I.B. Tan R.B. Keus A.A.M. Hart Stage as major long term outcome predictor in minor salivary gland carcinoma Cancer 89 1195 1204 1:STN:280:DC%2BD3cvltFahsQ%3D%3D 10.1002/1097-0142(20000915)89:6<1195::aid-cncr2>3.3.co;2-a 11002213
R.M. Baskin B.J. Boyce R. Amdur W.M. Mendenhall K. Hitchcock N. Silver et al. Transoral robotic surgery for oropharyngeal cancer: patient selection and special considerations Cancer Manag Res 10 839 846 10.2147/CMAR.S118891 29719420 5916264
L.X. Barrette E. De Ravin R.M. Carey L.J. Mady S.B. Cannady R.M. Brody Reconstruction following transoral robotic surgery for head and neck cancer: systematic review Head Neck 44 1246 1254 10.1002/HED.26998 35137993
G.S. Weinstein B.W. O’Malley A. Rinaldo C.E. Silver J.A. Werner A. Ferlito Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer Eur Arch Otorhinolaryngol 272 1551 1552 10.1007/S00405-014-3331-9 25327689
F. Gaino P. Gorphe V. Vander Poorten F.C. Holsinger R.B. Lira U. Duvvuri et al. Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: the Pharyngoscore Head Neck 43 3010 3021 10.1002/HED.26792 34132440
J. Gleysteen S. Troob T. Light D. Brickman D. Clayburgh P. Andersen et al. The impact of prophylactic external carotid artery ligation on postoperative bleeding after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma Oral Oncol 70 1 6 10.1016/J.ORALONCOLOGY.2017.04.014 28622885
A.C. Nichols J. Theurer E. Prisman N. Read E. Berthelet E. Tran et al. Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial Lancet Oncol 20 1349 1359 1:CAS:528:DC%2BC1MXhsFOitrrL 10.1016/S1470-2045(19)30410-3 31416685
R. Sethia A.C. Yumusakhuylu I. Ozbay V. Diavolitsis N.V. Brown S. Zhao et al. Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer Laryngoscope 128 403 411 10.1002/LARY.26796 28771728
V. Poissonnet E. Chabrillac P. Schultz S. Morinière P. Gorphe B. Baujat et al. Airway management during transoral robotic surgery for head and neck cancers: a French GETTEC group survey Eur Arch Otorhinolaryngol 279 3619 3627 10.1007/S00405-021-07188-4 35066651
J. Jeyarajah I. Ahmad E. Jacovou Anaesthesia and perioperative care for transoral robotic surgery ORL J Otorhinolaryngol Relat Spec 80 125 133 1:STN:280:DC%2BB3czltV2jug%3D%3D 10.1159/000490598 30278463
S. William R. Jad L. Georges F. Robert L. Ferris C.H. Floyd T.T.M. Meghan Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review Laryngoscope 10.1002/lary.28580
R. Mandal U. Duvvuri R.L. Ferris T.M. Kaffenberger G.W. Choby S. Kim Analysis of post-transoral robotic-assisted surgery hemorrhage: Frequency, outcomes, and prevention Head Neck 38 Suppl 1 E776 E782 10.1002/HED.24101 25916790
F.D. Leonhardt H. Quon M. Abrahão B.W. O’Malley G.S. Weinstein Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function Head Neck 34 146 154 10.1002/HED.21688 21469248
P.T. Dziegielewski T.N. Teknos K. Durmus M. Old A. Agrawal K. Kakarala et al. Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes JAMA Otolaryngol Head Neck Surg 139 1099 1108 10.1001/JAMAOTO.2013.2747 23576186 4274181
