City of Hope surgeons are now offering minimally invasive robotic surgery for certain head and neck cancers — a technology that could dramatically improve quality of life for patients.
Called transoral robotic surgery, or TORS, the approach allows surgeons to remove selective oropharyngeal cancers through the mouth, avoiding the need to split the lip or chin to reach tumor tissue. Oropharyngeal cancers include tumors on the base of the tongue, the back or sides of the throat, the tonsils and the soft palate. The Food and Drug Administration cleared the use of robotic surgery to treat these cancers in December 2009.
Ellie Maghami, M.D., chief of the Division of Otolaryngology/Head and Neck Surgery, and her associate, Renee Penn, M.D., assistant professor of surgery, both have undergone training in TORS, and they recently performed the institution’s first head and neck surgery using the da Vinci Surgical System.
City of Hope is one of only a small number of centers offering these procedures, and one of only two centers in California.
Maghami sees the technology as a significant improvement for patients because it offers a minimally invasive surgical alternative for several cancers that otherwise are treated with combination chemoradiation therapy, which some patients cannot tolerate well.
“In the last couple of decades, an overwhelming majority of patients with oropharyngeal cancers have been treated with combination chemoradiation, but we now know that this treatment can have significant long-term, undesirable side effects,” Maghami said. “And treatment of these cancers through standard surgery has required open facial approaches with splitting of the mandible, tracheostomy, and often the need for tissue transfer from elsewhere in the body, known as a flap, to reconstruct the anatomic defect created.”
These standard surgeries are invasive and lengthy, and while some patients recover their form and function well, others do not.
“With robotic surgery, some far-reach tumors can be removed through the open mouth under magnification with precise robotic arms and instrumentation without the need for facial transgression to provide the needed access,” Maghami said. “Patients recover quicker, with less pain, no facial scars, and frequently without the added risk of complications associated with a flap.”
This minimally invasive approach frequently leads to better speech and swallowing than what is seen in open approaches, she added. Patients also recover faster, with quicker return to function and shorter hospital stays.
Outcome studies from the University of Pennsylvania, which pioneered the procedure in the U.S., show that the technique is as effective as traditional surgery in treating some cancers in selective patients.
The surgeons currently offer the technique for patients with stage I or II (T1 or T2) oropharyngeal cancers, although eligibility also depends on patients’ anatomy. To perform the procedure, surgeons must be able to safely reach the tumor site with the use of the robotic arms, which carry specially articulated surgical instruments that can bend to get to hard-to-reach, tight spaces in the throat without harming important blood vessels.
The robotic approach adds to the breadth of the Division of Otolaryngology/Head and Neck Surgery’s offerings. In 2009, the surgeons were trained in transoral laser microsurgery, a technique in which surgeons use a microscope and laser to view and resect cancer in the throat without opening the neck. These techniques are easily integrated and complement the robotic procedures, Maghami said.
Recent technological innovations and physicians’ advanced training offer advantages for patients. Noted Maghami: “The Division of Otolaryngology/Head and Neck Surgery at City of Hope strives to provide the best in new approaches and therapies to facilitate both cancer cure and quality of life for head and neck cancer patients.”