Robots, once the center of science fiction, are now helping surgeons in the operating room with good success. They don’t actually do the surgery, but they’re an advanced tool that helps surgeons be more precise and efficient. Robot assisted surgery (RAS) is used in various specialties and now, patients with early stage cancers of the mouth and neck are benefitting too. Research shows that those who had transoral robotic surgery (TORS) did better after surgery than patients who had traditional surgery.
The first ever TORS procedure was performed in 2005 in a clinical trial at Penn Medicine in Philadelphia. This led the way to FDA approval of the procedure in 2009. Between 2010 and 2015, the number of patients who underwent TORS doubled and so did the number of locations where patients could get this kind of surgery.
Better Outcomes with TORS
Tumors at the back of the throat or under the tongue are often hard to reach. Unlike traditional surgery where surgeons must make large incisions and cut through the jaw to reach the target area, RAS is done with minimal incisions. It uses a camera, light and specialized tools attached to a flexible tube, which makes it easier to see and remove the tumor. Traditional surgery can result in scarring, skin grafts and disfigurement. After surgery, these patients may have trouble opening their mouth, eating, swallowing and even speaking. Some need a feeding tube that goes directly into their stomach. These issues can be permanent, but they can be avoided with RAS.
Patients recover faster and experience fewer side effects with robotic surgery. RAS is so precise that it can remove the entire tumor, which means patients often don’t need further treatment like chemoradiation – chemotherapy plus radiation therapy – after surgery. There is less pain, no scars and the patients live longer.
Causes of Cancer in the Mouth and Neck
According to The National Cancer Institute about 75% of mouth and neck cancers are caused when people use both tobacco (including chewing tobacco) and alcohol. Men develop mouth and neck cancer 4 times more often than women, and the number of cases of HPV mouth and neck cancers in men over 65 is expected to continue to rise.
At least 70% of throat cancers are caused by HPV, a sexually transmitted infection. Although most types of HPV are harmless, certain strains can eventually cause cancer. The Oral Cancer Foundation reports that HPV cancers are often found at the back of the mouth where they do not cause any pain, making them harder to notice until they have progressed.
Quality of Life After Surgery Differs Between Surgeries
The invasiveness of traditional surgery can cause a disturbing change in appearance, resulting in emotional problems and isolation as patients avoid going out. This is such a problem that a study from 2017 estimated that 15% to 50% of these patients were depressed and had a high suicide rate. Some patients actually wished they had not had the operation as they hated looking in the mirror and avoided socializing with family and friends. TORS doesn’t leave any scars.
Patients who have RAS generally have a better quality of life. They report having less pain post-operatively, and they experience less bleeding and fewer infections. They also go home sooner and recover faster. The study found that patients with cervical, endometrial or prostate cancer did not live longer if they had RAS rather than traditional surgery. Although the survival rate was not better for some, enduring less pain and scarring can mean a better quality of life. And for some patients, quality of life is more important than a longer life after a cancer diagnosis.