Clinician-to-Clinician Update Clinician-to-Clinician Update

Technological Breakthroughs in Minimally Invasive Head and Neck Cancer Surgery

February 2015

Surgical resection is often indicated for patients with cancers of the head and neck and has historically been associated with significant morbidity. Over the past several years, the University of Minnesota Cancer Care treatment team has made breakthroughs in reducing the invasiveness of these surgeries through the use of leading-edge, novel technology. Two key examples of this are transoral robotic surgery for cancers of the mouth and neck and endonasal endoscopic surgery for tumors in and around the skull base and sinuses.

Transoral Robotic Surgery

Transoral robotic surgery (TORS) is a minimally invasive surgical technique carried out through the mouth in which the surgeon controls highly specialized robotic arms to perform complex procedures in the head and neck.1 Using a kinematic system, the surgical robot allows the controlling surgeon at the console to use natural, open-surgery techniques, which are instantaneously converted into minimally invasive procedures at the surgical field.

TORS enables our head and neck surgeons to safely resect oropharyngeal tumors that would have previously required a lip-split incision and/or mandibulotomy.2 Our surgeons also utilize TORS to assist with reconstructive surgery that involves a microvascular tissue transfer (also called a free flap)3. Some of the benefits of TORS over a conventional, open surgical approach include decreased blood loss, decreased postsurgical pain, decreased length of stay (2 to 3 days versus 7 to 10 days with conventional surgery), a faster return to normal activities and to normal speech and swallowing, and a lack of external scarring.4

When the less-invasive approach and advanced reconstruction techniques are used with TORS, patients with head and neck cancers report a high level of health-related quality of life at 1 year postsurgery.5, 6, 7

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Endoscopic Endonasal Skull Base Surgery

Endoscopic endonasal surgery was first applied only to addressing pituitary lesions. However, the endonasal route now allows safe approach to the anterior cranial base, suprasellar region, clivus, cavernous sinus, craniovertebral junction and other critical areas of the skull base, without requiring external incisions. Compared with traditional transcranial surgery, endoscopic endonasal skull base surgery poses several advantages. These include an improved visualization of and access to deeply seated lesions, decreased risk of brain parenchyma injury, a lack of neurovascular structure manipulation, early tumor devascularization, and decreased surgery time. It also avoids external scarring and provides increased patient comfort and decreased length of hospital stay (3 to 5 days versus 7 to 9 days with traditional surgery)8 .

As with all evolving techniques, endoscopic endonasal skull base surgery involves a learning curve, and complication rates are much higher for surgical teams early on in the learning process.9 At University of Minnesota Medical Center, our multidisciplinary skull base surgery teams perform 80–100 endoscopic endonasal skull base procedures annually. In every team, we draw upon the skilled expertise of a neurosurgeon, an otolaryngologist, and a neuroradiologist, and we collaborate with a neuro-oncologist, neuro-ophthalmologist, or endocrinologist as needed to ensure the best possible outcome for each patient.

References

1. Hans S, et al. Transoral robotic surgery in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129:32-7.

2. Mallet Y, et al. New challenge in head and neck oncology surgery: the transoral robotic surgery. Bull Cancer. 2010;97:97-105.

3. Song HG, et al. Robot-assisted free flap in head and neck reconstruction. Arch Plast Surg. 2013;40:353-358.

4. Selber JC, et al Transoral robotic reconstructive surgery. Semin Plast Surg. 2014 Feb;28(1):35-38.

5. Dziegielewski PT, et al. Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg. 2013;139:1099-1108.

6. Hurtuk AM, et al. Quality-of-life outcomes in transoral robotic surgery. Otolaryngol Head Neck Surg. 2012;146:68-73.

7. Durmus K, et al. Functional and quality-oflife outcomes of transoral robotic surgery for carcinoma of unknown primary. Laryngoscope. 2014;124(9):2089-2095.

8. Findings compiled from Eloy JA, et al. Laryngoscope. 2009 May;119(5):834-840. Wood JW, et al. Int Forum Allergy Rhinol. 2012 Nov;2(6):487- 495. Cohen MA, et al., ORL J Otorhinolaryngol Relat Spec. 2009;71(3):123-128. Nicolai P, et al. Am J Rhinol. 2008 May-Jun;22(3):308-316. 

9. Smith SJ, et al. Light at the end of the tunnel: the learning curve associated with endoscopic transsphenoidal skull base surgery. Skull Base. 2010;20:69-74.

When to Refer

We value our relationship with you, your patients, and your office staff. We work hard to keep you informed of your patients’ care by providing detailed reports, from diagnosis to treatment and follow-up. Our goal is to provide you with prompt service and communication for the patients that you refer to us.

To schedule a cancer consultation, referral or appointment:
855-486-7226

To schedule a physician meeting or visit:
612-867-3411

Collaborative Care
Many patients live long distances away from University of Minnesota Medical Center. To minimize travel difficulties and lost time from school or work for our patients, we are committed to partnering with the patient’s referring provider and other local providers. Some patients can be initially discussed over the phone in collaboration with the referring provider. We aim to expedite the process so that, in one trip to the Twin Cities, patients can be assessed and also complete surgery, if required. In many cases, care after discharge can also be provided locally.

Physician Outreach Program
The Cancer Care Outreach Program is designed to provide education and facilitate knowledge sharing between our team and the medical community.

To schedule a physician meeting or to visit our facility, contact Melinda Arvold, Oncology Outreach Manager. Phone: 612-867-3411.

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The Masonic Cancer Center is one of only 41 NCI-designated institutions in the United States, a designation awarded only to institutions that make ongoing, significant advances in cancer research, treatment, and education. View all current, active clinical trials available through University of Minnesota Cancer Care.

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