Robots, once the center of science fiction, are now helping surgeons in the operating room with great success. They don't perform the surgery, but they are an advanced tool that allows surgeons to be more precise and efficient. Robot-assisted surgery (RAS) is used in a variety of specialties, and now patients with early-stage mouth and throat cancer are also benefiting. Research shows that those who underwent transoral robotic surgery (TORS) did better after the operation than patients who underwent traditional surgery.
The first TORS procedure was performed in a 2005 clinical study at Penn Medicine in Philadelphia. This led to the approval of the process by the FDA in 2009. Between 2010 and 2015, the number of patients who had TORS performed doubled, as did the number of places where patients could receive this type of surgery.
Better results with TORS
Tumors in the throat or under the tongue are often difficult to reach. Unlike traditional surgery, where surgeons make large incisions and have to cut the jaw to reach the target area, RAS is performed with minimal incisions. It uses a camera, light, and special tools attached to flexible tubing, which makes it easier to identify and remove the tumor. Traditional surgeries can lead to scars, skin grafts, and disfigurements. After surgery, these patients may have trouble opening their mouths, eating, swallowing, and even speaking. Some need a feeding tube that goes straight to the stomach. These problems can be permanent, but RAS can avoid them.
Patients recover faster and have fewer side effects from robotic operations. RAS is so precise that it can remove the entire tumor, which means that patients often don't need further treatment, such as chemoradiotherapy – chemotherapy plus radiation – after surgery. There is less pain, no scars, and patients live longer.
Causes of cancer of the mouth and throat
According to the National Cancer Institute, about 75% of mouth and throat cancers are caused when people use both tobacco (including chewing tobacco) and alcohol. Men are four times more likely to develop mouth and throat cancer than women, and the number of HPV mouth and throat cancer cases in men over 65 is expected to continue to increase.
At least 70% of larynx 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 often appear in the back of the mouth where they don't cause pain, making them harder to notice until they progress.
The quality of life after the operation differs between the operations
The invasiveness of traditional surgery can lead to a disruptive change in appearance, leading to emotional problems and isolation as patients avoid going out. This is such a problem that a 2017 study estimated that 15% to 50% of these patients were depressed and had a high rate of suicide. Some patients actually wish they hadn't had the surgery because they hated looking in the mirror and avoided socializing with family and friends. TORS leaves no scars.
Patients with RAS generally have a better quality of life. They report that they experience less pain post-operatively and have less bleeding and fewer infections. You will also go home earlier and recover faster. The study found that patients with cervical, endometrial, or prostate cancer did not live longer if they had RAS instead of traditional surgery. While survival rates haven't been 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 longer life after a cancer diagnosis.