Healthcare Improvement Scotland, SHTG team, December 2017
Key points
- Head and neck cancer of unknown primary
- In small single-arm case series, tumour detection rates for transoral robotic surgery (TORS) tongue base mucosectomy or lingual tonsillectomy in patients with head and neck cancer of unknown primary ranged from 51% to 54%. The extent of prior investigation that defined head and neck cancer of unknown primary varied between studies. No studies were identified that directly compared detection rates from different diagnostic strategies.
- No cost effectiveness studies were identified that compared TORS tongue base mucosectomy or lingual tonsillectomy with blind biopsy in patients with head and neck cancer of unknown primary.
- Oropharyngeal cancer
- Small non-randomised observational studies comparing TORS with (chemo)radiotherapy reported no statistically significant differences in overall or disease-free survival in patients with oropharyngeal cancer. These studies were retrospective and at risk of bias, particularly relating to patient selection.
- Evidence on survival in small non-randomised studies that compared TORS with conventional transoral or open surgery in patients with oropharyngeal cancer was inconsistent, involved different patient populations, and was at risk of selection bias.
- In oropharyngeal cancer patients, swallowing-related quality of life was statistically significantly better in patients treated with TORS compared with (chemo) radiotherapy at varying follow-up points up to 12 months post-treatment.
- The evidence on whether TORS is cost-effective at UK willingness-to-pay thresholds in patients with oropharyngeal cancer was unclear and results may not be applicable to the UK setting.
- Supraglottic laryngeal cancer
- No studies were identified that directly compared TORS with radiotherapy in patients with supraglottic laryngeal cancer. The evidence base consists of single-arm case series. No conclusions could therefore be reached on the clinical or cost-effectiveness of TORS in this patient group.
- Patient and social aspects
- No studies explored patient experiences or preferences relating to TORS. Evidence from two qualitative studies suggests that treatment of head and neck cancer with open surgery or (chemo)radiotherapy can have a significant impact on the physical and psychosocial functioning of patients. A narrative systematic review found that head and neck cancer patients rated survival, cure, pain and swallowing outcomes as important.
- Learning curve and volume-outcome
- In a retrospective cohort study the TORS surgical learning curve for oropharyngeal cancer varied by surgeon (n=3). Competence was potentially reached after 15–40 cases depending on the outcome measured.
- In a recent retrospective analysis hospitals with high TORS volume were associated with statistically significantly lower positive margin rates compared with low volume hospitals: 8.2% versus 16.7%, p=0.001.
