Transoral robotic surgery (TORS) for the treatment of oropharyngeal and supraglottic laryngeal cancers

Recommendation for NHSScotland

Evidence from qualitative studies on head and neck cancer patient experiences of (chemo)radiotherapy and open surgery suggests that these treatments can have a considerable impact on the physical and psychosocial functioning of patients.

Studies comparing transoral robotic surgery (TORS) with (chemo)radiotherapy or conventional surgery for the treatment of oropharyngeal cancer were all non-randomised observational studies.

Oropharyngeal cancer: TORS versus (chemo)radiotherapy

• There were no statistically significant differences in survival in comparisons of TORS with (chemo)radiotherapy in patients with primary oropharyngeal cancer. Swallowing function was statistically significantly better in the TORS group.
• Evidence on whether TORS is cost-effective in patients with oropharyngeal cancer was inconclusive. The findings tended to indicate that TORS was not cost effective, yet the studies were based on a non-UK setting which limits the generalisability of the results.

Oropharyngeal cancer: TORS versus conventional surgery

• Findings from studies comparing TORS with conventional surgery (open or transoral) in patients with oropharyngeal cancer were inconclusive.
• A proportion of patients undergoing open surgery experience long-term speech impairment, disfigurement or pain. TORS may therefore be an appropriate treatment to consider in patients with recurrent oropharyngeal cancer where conventional open surgery may be the only alternative treatment.

Supraglottic laryngeal cancer: TORS versus radiotherapy

• Evidence on TORS in supraglottic laryngeal cancer patients was limited to small non-comparative case series. No conclusions could be reached on the clinical or cost-effectiveness of TORS in patients with supraglottic laryngeal cancer due to a lack of studies comparing TORS with radiotherapy.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

Da Vinci robotic surgical devices are a relatively new technology which is available at three centres in NHSScotland. These devices are currently used predominantly to provide a laparoscopic prostatectomy service. To ensure the devices are optimally employed, NHSScotland is considering expanding the indications for which robotic surgery is available.

Why is this important?

This work was accepted onto the SHTG programme as a priority to support evidence-informed use of robotic surgery capacity.

Referred by

West of Scotland Cancer Network