Until recently, many patients with cancers arising at the very back of the mouth and throat received high-dose radiation and chemotherapy, with often severe and persisting side effects.
This was because these lesions were hard to reach with conventional surgery and the approaches could be very invasive and disfiguring.
Robotic surgery has developed to allow a more minimally invasive approach to re-sect cancers of the tongue base and tonsils without causing disfigurement. The implications of this can be to minimise the use of radiation and chemotherapy leading to improved quality of life for patients.
Luke Cascarini was one of the first head and neck surgeons in the UK to be trained to undertake these procedures safely.
Why robotic surgery is increasingly important
Shifting demographics of head and neck cancer
The ‘typical’ patient with early-stage cancer at the very back of the tongue or tonsil have changed substantially in recent decades. Now it is well recognised that patients are younger and more likely to survive the cancer. HPV – human papilloma virus has been shown to be behind this change and this has now been recognised in the staging systems for head and neck cancer.
This group of patients treatment needs has shifted, with 90% of these patients expected to survive, a growing importance is now being placed on cancer survivorship and quality of life as the old conventional treatments can significantly impact on appearance, speech and swallowing.
Side effects of open surgery or radiation therapy for cancers of the oropharynx
The standard treatment of chemotherapy and radiotherapy for early-stage throat cancer led to good survival rates and avoided the need for open surgery which involved splitting the jaw.
Unfortunately this combination often lead to serious long-term toxic effects, including breakdown of the jaw (Termed Osteoradionecrosis – which can require very extensive surgery to treat), chronic dry mouth, and dysphagia that can necessitate the placement of a temporary or permanent feeding tube in the stomach. Radiation and chemotherapy helps to preserve the structures involved but can significantly compromise important speech and swallowing function and thus diminish quality of life.
Surgery to reduce the side-effects of treatment – Transoral robotic surgery (TORS)
Using the Da Vinci surgical system for transoral robotic surgery (TORS), your surgeon can access the cancers via a minimally invasive approach via the mouth rather than performing open surgery.
Advantages of robotic surgery
In TORS, head and neck surgeons remotely manipulate flexible robotic arms and cameras to control surgical instruments further back in the throat than is possible with their hands alone. This gives your surgeons the advantage of being able to manoeuvre the instruments in very tight spaces and see and avoid important structures in the throat.
Your surgeon is therefore able to safely re-sect many tumors with a clear margin. For these patients, radiotherapy and chemotherapy can be omitted or given at lower doses to reduce the side effects.