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LOS ANGELES, U.S.: Owing to its considerable benefits, including being minimally invasive, robot-assisted surgery is gaining increasing recognition in many medical fields, including dentistry. In 2019, the U.S. Food and Drug Administration (FDA) cleared the first robotic device for dental surgery, and the device is commercially available in the country. Now, new research has shown that robotic surgery may improve survival rates in early-stage oropharyngeal squamous cell carcinoma patients.
According to the World Health Organization, there are approximately 657,000 new cases of cancers of the oral cavity and pharynx each year and over 330,000 associated deaths. The Oral Cancer Foundation recently reported that 53,000 Americans will be diagnosed with oral or oropharyngeal cancer this year alone. Oropharyngeal cancer has a well-established association with human papillomavirus (HPV) infection and is more common in men than in women. At the beginning of the year, Dental Tribune International reported on a novel technology that may help detect HPV and subsequently improve early diagnosis of mouth and throat cancer.
Transoral robotic surgery on the rise
Transoral robotic surgery is a minimally invasive procedure that allows doctors and dental professionals to perform complex medical procedures on patients while keeping a safe distance, which may now prove to be more important than ever in light of the SARS-CoV-2 pandemic. Researchers from Cedars-Sinai hospital in Los Angeles observed that an increasing number of patients—from 18.3% in 2010 to 35.5% in 2015—underwent transoral robotic surgery for early-stage oropharyngeal cancer after the procedure was approved by the FDA in 2009. Additionally, the number of facilities performing transoral robotic surgery during that same period increased dramatically, from 6.3% to 13.9%.
“It’s reassuring to our patients that their survival rate is the same if not better with robotic surgery”
— Dr. Anthony T. Nguyen, Cedars-Sinai
This prompted the investigators to examine whether robotic surgery is superior to other treatments for oropharyngeal cancer patients, such as standard surgery, radiation therapy and chemotherapy. The study used data from the National Cancer Database and included 9,745 surgical patients. Approximately a third of the patients underwent transoral robotic surgery between 2010 and 2015, and the findings reported that the five-year overall survival rate for these patients was 84.5%, compared with 80.3% for patients who had nonrobotic surgery.
“At a minimum, robotic surgery for oropharyngeal cancer patients seems safe and effective compared to what’s been the standard of care for many years,” senior author Dr. Zachary S. Zumsteg, assistant professor of radiation oncology at Cedars-Sinai, said in a press release.
In addition to increased overall survival rates, the researchers found that robotic surgery was associated with lower rates of positive surgical margins—which indicates that there are some cancerous cells at the edges of the resected tissue and thus further treatment is likely needed—12.5%, compared with a rate of 20.3% for nonrobotic surgery. Furthermore, robotic surgery was linked with reduced use of postoperative chemoradiation, 28.6%, compared with 35.7% for patients who had nonrobotic surgery.
“Our purpose in doing this study was to see how this new technology, which has never been tested in a randomized, controlled trial, has influenced patterns of treatment and outcomes since its FDA approval,” Zumsteg said. “There is a learning curve with any new surgical technique, and new ones don’t always translate into equal or improved outcomes,” he continued.
“Meanwhile, it’s reassuring to our patients that their survival rate is the same if not better with robotic surgery and they have the potential for a better quality of life,” lead author Dr. Anthony T. Nguyen, a resident in the Department of Radiation Oncology at Cedars-Sinai, said in the same press release.
The study, titled “Comparison of survival after transoral robotic surgery vs nonrobotic surgery in patients with early-stage oropharyngeal squamous cell carcinoma,” was published online on Aug. 20, 2020, in JAMA Oncology, ahead of inclusion in an issue.
Editorial note: More information about Yomi, the world’s first robot-assisted dental surgical system, can be found here.