Ninety-day Mortality Following Transoral Robotic Surgery or Radiation at Commission on Cancer-accredited Facilities

Authors

James R Janopaul-Naylor
Manali Rupji
Rachel A Tobillo
Joshua W Lorenz
Jeffrey M Switchenko
Sibo Tian
Azeem S Kaka
David C Qian
Ashley J Schlafstein
Conor E Steuer
Jill S Remick
Soumon Rudra
Mark W McDonald
Nabil F Saba
William A Stokes
Mihir R Patel
James E Bates

Publication Date

3-1-2023

Journal

Head & Neck

Abstract

BACKGROUND: Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown.

METHODS: NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities.

RESULTS: 3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p < 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality.

CONCLUSIONS: There is minimal difference between 90-day mortality in patients treated with TORS or radiotherapy for early-stage OPSCC. While overall rates are low, for patients with expectation of cure, work is needed to identify optimal treatment.

Keywords

90-day mortality, organ preservation, oropharynx cancer, postoperative mortality, radiotherapy, transoral robotic surgery