Some patients with cancer of the throat and surrounding areas have a new surgical option — one that could put their post-treatment quality of life head and shoulders above what previous methods offered.
City of Hope surgeons now offer TORS, short for transoral robotic surgery. It’s a minimally invasive robotic-assisted surgery for certain head and neck cancers. City of Hope is one of only a small number of centers offering TORS, and one of only two centers in California.
TORS lets surgeons remove select oropharyngeal cancers through the mouth, so they don’t have 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.
City of Hope’s Ellie Maghami, M.D., chief of the Division of Otolaryngology/Head and Neck Surgery, and Renee Penn, M.D., assistant professor of surgery, recently performed the institution’s first TORS procedure.
Maghami sees TORS as a major improvement for patients. It offers a minimally invasive option for several cancers that otherwise would receive a combination of chemotherapy and radiation 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.
Traditionally, treatment of these cancers with standard surgery has required open facial approaches. This involves splitting the lower jaw and creating a breathing hole in the throat called a tracheostomy. And often the open procedure requires the use of a flap — tissue from elsewhere in the body surgeons use to reconstruct the changes created by the surgery.
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 often leads to better speech and swallowing compared to open approaches, she added. And patients can have shorter hospital stays and return to normal function quicker.
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 cancers in select patients.
The robotic approach adds to the breadth of City of Hope’s offerings. In 2009, surgeons were trained in transoral laser microsurgery. In that technique, surgeons use a microscope and laser to view and remove cancer in the throat without opening the neck. The method fits well with the robotic procedures, Maghami said.